OVERVIEW of medicare plans
Original Medicare (Parts A & B):
What Original Medicare Covers
- Part A (Hospital Insurance): Inpatient hospital stays, short-term skilled nursing care, hospice, and limited home health care.
- Part B (Medical Insurance): Doctor visits, outpatient care, preventive services, and medical equipment like wheelchairs or walkers.
What Original Medicare Does NOT Cover
Despite its broad coverage, Original Medicare has significant gaps:
- Prescription Drugs: Requires a separate Part D plan for outpatient medications.
- Dental Care: Excludes routine cleanings, fillings, and dentures.
- Vision Care: Does not cover routine eye exams, glasses, or contact lenses.
- Hearing Services: No coverage for hearing exams or hearing aids.
- Long-Term Care: Excludes custodial care in nursing homes or assisted living.
- Overseas Healthcare: Limited to specific emergency cases outside the U.S.
- Cosmetic Surgery: Only covers medically necessary procedures.
- Routine Foot Care: Covered only for certain medical conditions like diabetes.
Medicare Part C, or Medicare Advantage, bridges the gap of Original Medicare (Parts A and B) by offering:
- Prescription Drug Coverage: Many plans bundle Part D for convenience.
- Cost Protection: Annual out-of-pocket maximum caps healthcare expenses, unlike Original Medicare.
- Streamlined Coverage: Combines hospital, medical, and sometimes drug coverage into one plan.
- Flexible Options: Choose from HMOs or PPOs tailored to your needs, often with localized plans.
Medicare Part C simplifies and may combine a Part D.
Medicare Part D: Prescription Drug Coverage
Starting in 2025, Medicare Part D will no longer include the Coverage Gap (Donut Hole) phase. Here’s how it will work:
- Available as:
- Prescription Drug Plans (PDPs): Stand-alone plans for Original Medicare.
- Medicare Advantage Plans (MAPD): Combines health and drug coverage in one plan.
- Simplified Coverage Stages in 2025:
- Deductible Stage: Pay the full cost until your deductible is met.
- Initial Coverage: Pay copays/coinsurance for prescriptions up to a new annual cap of $2,000 (no coverage gap).
- Catastrophic Coverage: After reaching the $2,000 out-of-pocket limit, pay minimal costs for the rest of the year.
- Why Enroll?
- Reduces medication expenses.
- Avoids lifelong late enrollment penalties.
- Simplified structure offers predictable costs.
This updated structure provides beneficiaries with clearer and more manageable drug coverage.
Medicare Supplement Plans and Part D
Medicare Supplement Insurance Plans (Medigap):
- Help cover out-of-pocket costs like copayments, coinsurance, and deductibles that Original Medicare doesn’t pay.
- Popular plan options include Plans F, G, and N, providing varying levels of coverage.
- Works alongside Original Medicare (Parts A and B).
Medicare Part D (Prescription Drug Coverage):
- Provides coverage for outpatient prescription drugs, which are not included in Original Medicare.
- Can be purchased as a stand-alone plan or bundled with a Medicare Advantage Plan.
Benefits of Medicare Supplements and Part D Together:
- Offers financial protection by reducing unexpected medical and prescription costs.
- Ensures comprehensive coverage beyond what Original Medicare provides.