Learn how Medicare coverage works and what different plans may include, from hospital and medical services to prescription drugs, dental, vision, hearing, and supplemental coverage. This informational guide explains Original Medicare, Medicare Advantage, Medigap, and important factors to consider when understanding how different Medicare coverage options work.
People searching for a Medicare plan that covers everything may be looking for one option that combines hospital care, medical services, prescription drugs, and additional benefits. However, Medicare coverage is not designed as one universal plan that covers every healthcare service or expense. Original Medicare includes Part A and Part B, while Medicare Advantage plans combine Part A and Part B and usually include Part D. Some plans may also offer additional benefits. Medigap can help with certain out of pocket costs under Original Medicare. Understanding these differences can help people evaluate what types of coverage may be available for their healthcare needs.
There is no single Medicare plan that automatically covers every healthcare service and expense. Medicare has different parts and coverage options, each serving a particular purpose. Original Medicare consists of Part A and Part B, while Medicare Advantage provides an alternative way to receive Medicare benefits through a Medicare approved private plan.
Common areas of Medicare coverage include:
Medicare Advantage, also called Part C, is an alternative to Original Medicare. These plans are offered by Medicare approved private companies and must cover medically necessary services covered by Original Medicare. Many plans also provide additional benefits that Original Medicare generally does not cover.
Depending on the plan, additional benefits may include:
Medicare Advantage plans can have provider networks, plan specific costs, and rules such as prior authorization for certain services, so reviewing individual plan details is important.
Medicare Supplement Insurance, commonly called Medigap, works with Original Medicare rather than replacing it. Medigap policies can help cover certain out of pocket costs associated with Part A and Part B, including some copayments, coinsurance, and deductibles.
Important points to understand include:
When researching Medicare options, it can be useful to look beyond the idea of a plan that covers everything. Different plans can have different provider networks, costs, benefits, and coverage rules.
Consider reviewing:
Original Medicare generally allows beneficiaries to use any doctor or hospital that accepts Medicare, while Medicare Advantage plans may have network and service area requirements.