Medicare Decision Guide Keeps It Simple

Whether you’re new to Medicare or considering changing your Medicare choices, one of the main decisions you need to make is how you want to receive your Medicare coverage. Medicare Made Clear’s Decision Guide can help you make the choice that’s right for you.

First Things First

You can enroll in Medicare Part A, Part B or both. Part A covers care you receive in a hospital or skilled nursing facility. Part B covers doctor visits and outpatient care.

Part A is premium free for most people. You must pay a monthly premium to Medicare for Part B. People who are working and covered under their (or their working spouse’s) employer or union health plan may decide to delay enrolling in Part B. If you decide to enroll later, you must qualify for a Special Enrollment Period to avoid a late-enrollment penalty.

Original Medicare or Medicare Advantage?

People who are enrolled or choose to enroll in both Parts A and B can receive their benefits through Original Medicare or through a Medicare Advantage plan (Part C).

Original Medicare is administered by the federal government. The coverage and cost terms and conditions are the same for everyone, no matter where you live. Medicare Advantage plans are offered by private insurance companies approved by Medicare. Coverage and cost terms and conditions vary from plan to plan. Plans are offered regionally, and you can choose from the plans that are available where you live. You can use the Plan Finder at Medicare.gov to find plans in your area.

Medicare Made Clear’s Decision Guide presents the two choices—Original Medicare or Medicare Advantage—in a clear and simple graphic. You can follow each path and see what’s included with each kind of coverage. Handy links within the graphic lead you to more information.

Additional Coverage or Combined Coverage?

As the Decision Guide shows, you may need to purchase additional insurance to help pay for some services that Original Medicare doesn’t cover. For example, Original Medicare does not cover prescription drugs. In addition, you pay 20% of the cost for doctor visits under Original Medicare. Some people choose to add Medicare supplement insurance (Medigap) and prescription drug (Part D)plans to help cover these costs.

Medicare Advantage plans must include, at minimum, the same coverage offered by Original Medicare. Most plans also include prescription drug coverage and extra benefits such as vision, dental and hearing exams—all combined in one plan.

Monthly premiums with a Medicare Advantage plan can be as low as $0, though you must continue to pay your Part B premium to Medicare. In addition, you will never pay more out-of-pocket than the limit set by Medicare ($6700 in 2012). There is no out-of-pocket limit with Original Medicare.