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Health coverage is a personal matter, and each person’s needs are different. That’s why you have choices for how to get your Medicare health and prescription drug coverage. For instance:

  • If you choose to join a Medicare Supplement plan and you want prescription drug coverage, you must join a Medicare Prescription Drug Plan (Part D).
  • If you choose to join a Medicare Advantage plan, the plan may include Medicare prescription drug coverage.
  • If you do not make a choice, you will have Medicare alone with very limited prescription drug benefits.

Here are some considerations to keep in mind when making your choice:

Cost

Do you prefer paying a lower premium or are you more concerned about keeping your out-of-pocket costs for health care (deductibles, copayments, coinsurance) lower?

Benefits

Do you want extra benefits beyond Medicare? Some plans include benefits for outpatient prescription drugs, vision, dental and hearing care.

Choice of Doctors

Is it important for you to have the freedom to choose any doctor? Are you comfortable with having a Primary Care Physician (PCP) coordinate your health care?

Travel

Do you spend part of every year in another state? If so, do you need a plan that will cover you while you are away?

Prescription Drugs

Are prescription drug benefits included in the plan? If so, are the medications you take on the plan’s list of covered drugs (also called a formulary)? Are the participating pharmacies convenient?

To assist you in making your choice, here is a chart showing a general side-by-side comparison of your coverage options:

Comparison of Medicare Plans Coverage

OPTION 1

OPTION 2

Original Medicare Plan (Part A and Part B)

  • Part A (Hospital Insurance) — most people pay no premium
  • Part B (Medical Insurance) — optional with fixed monthly premium that can change annually; some people will pay a higher premium due to their yearly income
  • Cost sharing, including deductibles and coinsurance
  • Unlimited out-of-pocket costs
  • Use of doctors in the U.S. who accept Medicare

Medicare Supplement

  • Helps cover the gaps in Original Medicare, including hospital and medical deductibles and coinsurance
  • Can be purchased from a private insurance company
  • You pay a separate premium
  • Use any doctor anywhere in the U.S. that accepts Medicare (convenient when traveling)
  • Your monthly premium = your Part B premium + a Medicare Supplement premium

Prescription Drug Plan (Part D)

  • Can be purchased from a private insurance company
  • Covers both brand name and generic drugs at participating pharmacies
  • You pay a separate premium

Medicare Advantage Plan (Part C)

  • Provides Original Medicare Part A and Part B benefits, and may include extra benefits for services like vision, dental and hearing care
  • Coverage is offered through private health insurance companies that have Medicare contracts with the Centers for Medicare & Medicaid Services
  • Usually has a network of doctors and hospitals and can include:
    - HMOs (Health Maintenance Organizations)
    - PPOs (Preferred Provider Organizations)
  • Medicare Advantage Part D (MAPD) plans include Part D prescription drug benefits
  • You can pay one premium and have one ID card for your medical and prescription drug coverage
  • Your monthly premium = your Part B premium, plus a Medicare Advantage plan premium

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