Original Medicare - Part A & B

What is it?

Original Medicare is the foundation of your coverage, made up of Part A and Part B. It provides your base level of protection, but there are out-of-pocket costs and no maximum on the amount you may spend. That’s why many people choose to add additional coverage for more complete protection.

What Does it Cover?

Part A - Hospital

  • Inpatient hospital stays

  • Skilled nursing facility care

  • Hospice care

  • Some home health care

Most people don't pay a premium for Part A.

Part B - Medical

  • Doctor visits

  • Outpatient care

  • Preventive services

  • Durable medical equipment

There’s a monthly premium for Part B which may vary based on your income.

What you may pay with Original Medicare

  • Over $1600 deductible for hospital stays (remember, this covers only room and board)

  • Potential daily hospital stay copays

  • Potential daily copays at a skilled nursing facility

Part A - Hospital

Part B - Medical

  • You’ll be responsible for 20% of most Part B services!

  • Part B annual deductible

These costs change on an annual basis.

Prescription Drug Plans
(Part D)

What is it?

Original Medicare does not include prescription drug coverage, which is why most people choose to enroll in a Part D plan. These plans are offered by private insurance companies and are designed to help protect you from high medication costs.

How Plans Work

Basic Plan Design

  • Typically, you pay an additional premium for the plan (unless included in a Medicare Advantage plan)

  • You pay a deductible, copays or coinsurance until the maximum out of pocket amount is reached.

  • Each plan has a different formulary or list of medications that it will cover.

  • Pharmacy networks vary by plan.

  • Plans are available as a stand alone policy OR are included as part of a Medicare Advantage plan.

  • You may be charged a penalty if you do not enroll when you’re first eligible.

  • Plans can change every year.

Keep Points

  • You pay 100% of all drug costs

  • Deductible may not apply to all drugs

  • Not all plans have a deductible

Stage 1 -
Annual Deductible

Part D Coverage Stages

  • You pay copays or coinsurance amounts

  • You stay in this stage until you reach the maximum out of pocket amount

Stage 2 -
Initial Coverage

  • You pay $0 for the rest of the year

Stage 3 -
Catastrophic Coverage

Medicare Supplement

Offered by private insurance companies, Medicare Supplement or Medigap plans help cover the costs not covered by Original Medicare (Parts A & B) such as:

  • Copayments

  • Coinsurance

  • Deductibles

You continue to pay your Part B premium and an additional premium for your Medicare Supplement plan.

You have the freedom to go to any doctor you choose.

Plan benefit structures are standardized, but costs vary by plan.

Prescription drug, dental, vision and hearing coverage NOT included.

Prescription Drugs with a Medicare Supplement Plan

If you choose a Medicare Supplement plan you will also have to enroll in a Part D or Prescription Drug Plan.

Prescription Drug Plans are offered through private insurance companies and help cover the cost of your prescription medications.

  • Medications covered on each plan varies

  • Plan pharmacy networks, benefits, premiums and costs can change on an annual basis.

  • There is a penalty if you do not enroll when first eligible.

Medicare Advantage
(Part C)

Offered by private insurance companies, these plans combine:

  • Part A (hospital)

  • Part B (medical)

  • Often Part D (prescription drug coverage)

  • Many include extra benefits like dental, vision, hearing, or wellness
    benefits

You must continue to pay your Part B premium and may pay an additional premium for your Medicare Advantage plan.

Benefits, premiums and costs can change on an annual basis.

Plans use a network of doctors and hospitals.

How Medicare Advantage Plans Work

Medicare Advantage plans work a lot like the health insurance you may have had through an employer or a spouse’s plan. Instead of Medicare paying your healthcare providers directly, a private insurance company administers your benefits and manages your care.

Some Medicare Advantage plans, have an annual deductible, many do not. After the deductible is met, you'll typically pay copays for your healthcare. A copay is a fixed dollar amount that you pay when you visit the doctor, see a specialist, or have testing done.

These costs continue until you reach your plan’s maximum out-of-pocket limit (MOOP). Once you reach this limit in a calendar year, your plan covers 100% of your Medicare-approved medical costs for the rest of the year.

Medicare Supplement vs. Medicare Advantage

Choosing between a Medicare Supplement and a Medicare Advantage plan is a personal decision that depends on your unique needs and circumstances. There are several important factors to consider, including your current health, budget, lifestyle, and how you prefer to access care. As you begin this journey, you’ll likely hear a lot of opinions about which option is “best.” Just remember that what works well for someone else may not be the right fit for you. Your Cardinal Insurance agent is here to make sure you understand the differences clearly and guide you toward the choice that fits you best.

MS vs MED ADV GRID by Cyndi Maharas