Medicare Coverage Choices
There are two main ways to get your Medicare coverage – Original Medicare or a Medicare Advantage Plan. The first step is to decide how you want to get your coverage.
Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare also offers two optional coverages, Medicare Part D (Prescription Drug Coverage) and Medicare Supplement Insurance (also known as Medigap).
Medicare Advantage Plan
Medicare Advantage Plans, also known as Medicare Part C (like an HMO or PPO) combines Part A, Part B, and usually Part D. Part D is Prescription Drug Coverage. Most Medicare Advantage Plans cover prescription drugs. You may be able to add drug coverage in some plan types if it is not already included. If you join a Medicare Advantage Plan, you cannot use and cannot be sold a Medigap policy.
Medicare and the Health Insurance Marketplace
The Health Insurance Marketplace is a way for qualified individuals, families, and employees of small businesses to get health coverage. Medicare isn’t part of the Marketplace.
If I have Medicare, do I need to do anything?
As long as you have Medicare Part A coverage, you’re considered covered and you don’t have to get any additional coverage. If you only have Medicare Part B, you aren’t considered to have minimum essential coverage. This means you may have to pay a fee for not having coverage.
Can I get a Marketplace plan instead of Medicare, or can I get a Marketplace plan in addition to Medicare?
Generally, no. In most cases, it’s against the law for someone who knows you have Medicare to sell you a Marketplace plan, because that would duplicate your coverage. However, if you’re employed and your employer offers employer-based coverage through the Marketplace, you may be eligible to get that type of coverage.
Note: The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare drug plans (Part D).
A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage.
If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.
Note: Medicare doesn’t pay any of your costs for a Medigap policy.
All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it.
Note: Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.