Types of Medicare Plans

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There are several different types of Medicare plans, which vary in their services and administrators. Those who are eligible for Medicare typically choose between the Original Medicare Plan and the Medicare Advantage Plan.

The Original Medicare Plan is a fee-for-service option that’s managed by the United States government. People with this plan have a combination of Part A and Part B benefits. They also have the option of adding a Medicare Prescription Drug Plan (Part D) or purchasing a supplemental policy or Medigap. Medicare Advantage Plans are a type of health care plan provided by a private company that contracts with Medicare. This option offers Parts A, B, and sometimes D coverage.

Here are the most common plans under Medicare:

Medicare Part A

Medicare Part A covers inpatient hospital care. It is offered to those who paid Medicare taxes while working, and those who haven’t paid Medicare taxes can still purchase Part A coverage. This coverage includes:

  • Inpatient hospital care – Covers up to 90 days each benefit period in a general hospital and up to 190 lifetime days in a Medicare-certified psychiatric hospital.

  • Skilled nursing facility care – Covers room, board, and a variety of other services in a skilled nursing facility for up to 100 days each benefit period.

  • Home health care – Covers healthcare services in the patient’s home up to 100 days of daily care or an unlimited amount of intermittent care.

  • Hospice care – Covers hospice care for terminally ill patients for as long as the provider certifies that care is needed.

Medicare Part B

Medicare Part B is optional and requires individuals to pay a monthly premium. Co-payments and deductibles can also apply to the services. Part B coverage includes:

  • Provider services – Services from a licensed health professional.

  • Durable medical equipment – Medical equipment that can be used in the home and withstand repeated use.

  • Preventative services – Screenings and counseling to detect conditions and prevent illness.

  • Therapy services – Outpatient physical, speech, and occupational therapy services.

Part B also covers ambulance services, mental health, x-rays and lab tests, chiropractic care, and select prescription drugs.

Medicare Part C – Medicare Advantage Plans

Medicare Part C consists of Medicare Advantage Plans, which are approved by Medicare and offered by private companies. These provide the same coverage as Parts A and B. These plans may also offer Part D prescription drug coverage. These plans include:

  • Preferred Provider Organization (PPO)

  • Health Maintenance Organizations (HMO)

  • Private Fee for Service Plans (PFFS)

  • Special Needs Plans

  • Medicare Medical Savings Account (MSA)

Medicare Part D – Prescription Drug Coverage

Medicare Part D provides prescription drug coverage from private companies approved by Medicare. This is optional for members and requires a monthly premium. Prescription drug coverage is also offered through private insurers who provide Medicare Advantage Plans. The cost and drug coverage depends on the plan chosen.

Medigap Policy or Medicare Supplemental Insurance

Medigap or Medicare Supplemental Insurance is a policy with 12 different plans intended to fill in the gaps left by the Original Medicare Plan. This option is offered by private companies and only applies to individuals who receive coverage through the Original Medicare Plan. Those who enroll in Medigap or supplemental insurance pay the insurance company a monthly premium in addition to the premium they pay for Part B.