Medicare is the health insurance program for people age 65 and older that helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
Medicare Part A (hospital insurance) helps pay for medical care in a hospital or for a limited time in a skilled nursing facility. Part A also pays for some home health care and hospice care.
Medicare Part B (medical insurance) helps pay for the services of doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Most people age 65 and older are eligible for free hospital health insurance (Part A) if they have worked and paid Medicare taxes long enough. You can enroll in Medicare health insurance (Part B) by paying a monthly fee.
Medigap and Medicare Advantage plans are options for people with Medicare and may offer additional benefits. But the two types of plans work very differently and can't be combined with each other—for example, you can't use your Medigap policy to pay Medicare Advantage plan copays, deductibles, and premiums.
Medigap is insurance that helps pay Medicare copays, coinsurance, and deductibles. It can be obtained only if the person enrolls in Original Medicare, which consists of Part A (hospitalization) and Part B (medical and outpatient services).
For example, if you have Original Medicare coverage (Part A and Part B), you can buy a Medigap policy as Medicare supplement insurance from a private insurance company at any time. Keep in mind that insurers may deny your enrollment or charge you a higher rate if you have pre-existing illnesses or other conditions.
The Medicare Advantage Plan (formerly known as Part C) is a comprehensive alternative to Original Medicare, offered by a private company with a Medicare contract. It includes all the benefits and services covered by Part A and Part B: prescription drugs and almost always the D with additional benefits, grouped in a single plan.
Unlike Original Medicare, which covers all doctors and other providers who accept Medicare, most Medicare Advantage plans have a network of providers and may charge more or not cover services from doctors or facilities that are not in the Medicare network. plan.
You can get a Medicare Advantage plan at the time of your initial enrollment in Medicare or in a few other situations. Otherwise, you'll have to wait until the open enrollment period, October 15-December 7, to have coverage starting January 1. Pre-existing conditions do not affect your right to get a Medicare Advantage plan.
If you have a Medicare Advantage plan, it is illegal for anyone to sell you a Medigap policy unless you are in the process of returning to Original Medicare.
How to choose between Medigap and Medicare Advantage
When deciding between a Medigap policy and a Medicare Advantage plan, the key factor is whether you want to receive your coverage from the federal government through Original Medicare or from a private insurer that offers Medicare Advantage plans.
If you choose Original Medicare, you can go to any doctor and facility that accepts Medicare. However, to fill in the coverage gaps, you'll need to buy separate policies for Medigap and Part D (prescription drugs).
If you choose Medicare Advantage, your payments may be low, however, your additional out-of-pocket costs will likely be different, especially if you go to an out-of-network doctor, the consultation may be not covered or your copay is higher.
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