5 Great Medicare Coverage Options for the Average American Senior

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No Two Medicare Plans Feature the Same Coverage

One of the most common misconceptions about Medicare is that all Medicare plan options are the same. Those new to Medicare may think that there’s only one plan and that it covers all medical expenses. In reality, there are several different Medicare plans, each of them covering different specific medical treatments and services.

The multitude of options for Medicare and the differences in coverage can make choosing a plan feel more confusing than it really is. Once you’ve read about different options, and you’re able to compare the different Medicare coverage options available in your area, choosing a plan that works for you becomes much easier.

At MedicareInsurance.com, we strive to help you better understand the different types of Medicare plans that are available to you. Today, we’re going to go over five of the best Medicare coverage options for the average American senior. To help you better find Medicare plan options that work for you, we’ll briefly discuss the pros and cons of each.

1: Original Medicare

1: Original Medicare

When we talk about “Original Medicare”, we’re talking about the two Medicare plans offered by the federal government combined into one package. The two Medicare plans that are offered by the federal government are Medicare Part A and Medicare Part B. Both offer different types of coverage, but together make a potent healthcare package that can help you get most of the coverage that you need.

Medicare Part A is also known as the hospital insurance portion of Original Medicare. This means that Medicare Part A will cover stays in the hospital or in a skilled nursing facility. It’s designed to cover inpatient hospital expenses that are deemed medically necessary by a doctor, including:

• A basic room
• Meals that fit a dietary plan made to help you recover during your stay
• Any medically necessary treatments and services

Medicare Part A will also cover home health care, nursing home care, care given in a skilled nursing facility, and hospice care for patients at the end of life. In order for Part A to cover any of these expenses, including hospital stays, the facilities and agencies must accept Medicare Part A.

Medicare Part B is known as the medical insurance portion of Original Medicare. Where Part A covers hospital stays, nursing facility stays, home health, and hospice care, Part B covers services and medical supplies delivered through outpatient treatment that are necessary to treat illnesses, diseases, or other conditions. Medicare Part B will cover:

• Lab tests
• Ambulance services
• Mental health treatment
• Durable medical equipment
• Preventive screenings and tests

When comparing Medicare coverage options, you’ll find that Original Medicare comes with many great pros, but it also features several cons. Let’s take a look at each below.

Pros of Original Medicare

• It’s cost-effective – many Americans do not pay a premium for Medicare Part A, and Medicare Part B monthly premiums start at prices as low as $170.10.
• You’re free to visit any provider that accepts Original Medicare.
• Original Medicare is accepted nationwide, meaning it’s easy to use if you’re traveling across the country.

Cons of Original Medicare

• Both only cover treatments and services related to their specific areas.
• There are no coverage options for vision, dental, and hearing care.
• There’s no out-of-pocket maximum, so costs can add up quickly.

2: Medicare Part B (Standalone)

Medicare Part A can be incredibly helpful if you require any of the following:

• Frequent hospital visits or stays
• Home health care
• End-of-life hospice care

However, if you stay relatively healthy and use your insurance for little more than checkups or lab work, Part A isn’t as useful. Part B, however, will cover most anything you could need as far as medical expenses.

As the medical insurance portion of Original Medicare, Medicare Part B is designed to cover two types of services: medically necessary services and preventive services. This makes Medicare Part B one of your best Medicare plan options because it will cover:

• Screenings for most major conditions, including diabetes and cancer
• Vaccinations
• Yearly wellness visits
• Clinical research trials
• Mental health care
• Certain outpatient prescription medications

As with all Medicare coverage options, Standalone Medicare Part B has certain good points and weak points. Let’s take a look at the pros and cons of Medicare Part B.

PROS:

• Part B will cover screenings for most every major condition or illness.
• Freedom to choose any healthcare provider that accepts Original Medicare.
• You can use Part B coverage at any provider that accepts it nationwide.
• Monthly premiums start at around $170.10.

CONS:

• If you need to visit the hospital, and you don’t have Medicare Part A, you will be forced to cover those expenses out-of-pocket as Part B does not cover hospital services.
• No coverage for hearing, dental, or vision care.
• You may be required to spend more out of your own pocket for medical expenses than you wish to spend.
• Monthly premium costs are based on income, meaning you could be paying as much as $578.30 per month for Medicare Part B coverage.

3: Medicare Advantage (Medicare Part C)

If you have Original Medicare, you may notice that the coverage can be kind of restrictive in some ways. While it covers most medical expenses, there are certain things that Original Medicare will not cover. Fortunately, there are other Medicare plan options that cover many of the things that Original Medicare does not.

Medicare Advantage, also known as Medicare Part C, is an option that’s offered by private insurance companies. They are authorized to offer these specialized Medicare plans by the federal government, but their coverage limits are not as restrictive. Because Medicare Advantage plan options are private plans offered by private providers, they’ll cover services, supplies, and treatments that are not covered by Medicare Part A and Part B.

For instance, most Medicare Advantage plans will cover:

• Vision care, such as eye exams, eyeglasses, and contact lenses.
• Hearing care, such as hearing aids and hearing exams.
• Dental care, such as cleanings and dentures.
• Transportation to and from appointments.
• Allowances to purchase over-the-counter medications and treatments.

When you’re comparing Medicare Advantage plan options, it’s a good idea to look at the positives and negatives of each offer before making a decision. Let’s examine some of the pros and cons of Medicare Advantage plans.

PROS:

• Many Medicare Advantage plan options offer coverage that rivals that of other Medicare coverage options, including Original Medicare.
• All-in-one coverage is available, meaning there are Medicare Advantage plans that will pair Part C coverage with Part D Prescription Drug coverage.
• Medicare Advantage plans offer the option to customize your benefits.
• Many plans offer what is known as a Part B premium reduction. 
• Many Medicare Advantage plan options start at a $0 premium.

CONS:

• Choice of providers who accept certain Medicare Advantage plans is restricted to local networks.
• Coverage is dependent on the rules and regulations of your provider and your state or county.
• You may end up paying additional upfront out-of-pocket costs for certain services or supplies.

4: Medicare Part D Prescription Drug Coverage

The cost of purchasing prescription medications is one of the highest-rising costs in our country today. Unfortunately, neither Original Medicare nor traditional Medicare Advantage plans cover the cost of prescription drugs. Unless you have a comprehensive all-in-one Medicare Advantage plan, you’ll end up paying costs for prescription medications out of pocket.

This begs the question: are there options for Medicare that can help cover the cost of prescription medications? Fortunately, the answer is yes. Medicare Part D Prescription Drug coverage is the only option out of the Medicare plan options that will cover prescription drug costs.

Medicare Part D can be obtained in two ways:

• As a standalone plan for those who have Original Medicare.
• As part of a comprehensive package with an all-in-one Medicare Advantage plan.

With a Part D Prescription Drug plan, you’ll pay less for your medications than what the open market calls for. Instead of full market price, you only pay a copay for your prescriptions. You’ll also pay less for generic medications that are already typically low-cost.

To help you best understand the Medicare plans available to you, let’s go over some of the pros and cons of Medicare Part D coverage.

PROS:

• Medicare Part D coverage can make the cost of purchasing high-cost medications for certain conditions more bearable.
• Part D plans must follow set coverage defined by Medicare, so your costs for prescriptions will always be a set amount.

CONS:

• Not all Medicare Part D plans cover the same medications. If your Part D coverage doesn’t cover the medication you need, you’ll end up paying the cost.
• Part D coverage rules feature certain restrictions on prescriptions that can be inconvenient to plan holders.

5: Medigap Supplemental Plans

If you have Original Medicare, there are Medicare coverage options that can help you fill in certain coverage gaps in the plan. Medicare Supplemental Insurance, which is also known as Medigap, is a specialized supplemental plan that works with Original Medicare. 

Medigap plans are designed to help you cover things that would otherwise be paid for out-of-pocket. For instance, Medigap plans can help you pay for:

• Deductibles
• Coinsurance
• Copays
• Overseas emergency health coverage

In order to obtain Medigap coverage, you must be enrolled in Original Medicare, as Medigap is not a standalone insurance plan. It also carries a separate monthly premium that you’ll pay in addition to your Medicare Part B monthly premium.

Let’s take a look at some of the pros and cons of Medigap plans.

PROS:

• Great for additional coverage that Original Medicare doesn’t provide.
• Will kick in to cover costs after Original Medicare pays its share.
• You’re covered outside the United States for medical services needed when traveling abroad.

CONS:

• Is a single-coverage policy, meaning that your Medigap policy will cover you only.
• Does not offer additional coverage for prescription drugs or hearing, dental, or vision care.

Only You Can Determine Which Coverage is Best For You

So, you may be asking, “Which of these offers the best Medicare options for me?” This is a question only you can answer. No one knows your healthcare needs better than you do. The type of coverage you require will help you determine which of these Medicare coverage options is right for you.

All Medicare plans come with their own pros and cons, and can help you cover medical costs that you may not be able to cover on your own. The only way to know which Medicare plan options, Medicare supplement options, and Medicare Advantage plan options will meet your needs is to research and compare them.

At MedicareInsurance.com, we offer a helpful tool that can help you find all of the best Medicare options available in your area. All you need to do is enter your zip code in our free plan finder below, and you’ll see a wide variety of quality Medicare plans that may meet your needs.

If you have additional questions about Medicare plans, our friendly, experienced, licensed agents are here to help answer any questions you may have. If you’d like to speak with one of our licensed agents, give us a call at (800) 950-0608. We’re here for you when you need us!