What Are The 4 Types of Medicare?

There are 4 types of Medicare and you have to choose one. The plan you choose can be critical and avoiding mistakes can be difficult. That’s because everyone wants to sell you there plan. Here’s an overview of your options and the pros and cons for each.

The 4 Types of Medicare Options

1. Original Medicare (Parts A & B)
2. Original Medicare Plus a Medigap Plan
3. Medicare Part C (Medicare Advantage)
4. Medicare Part D (Prescription Drug Plan)

The Medicare program is national. But only Original Medicare is national. Your other choices (Medicare Advantage and Medigap) are local. They vary significantly based on where you live.

That is why the Association stresses the value in speaking with an independent local Medicare insurance agent. Let her or she educate you about the local options. Call one  and you’ll be best prepared to make the right choice for your needs and budget.

Click to find Medicare Insurance agents in your area

Type 1. Original Medicare Parts A & B

Some 36 million Americans have Medicare Parts A &B.

People tend to call this Original Medicare or Traditional Medicare. It is the original program created and provided directly through the federal government.

If you don’t choose a different type of Medicare coverage, you’ll automatically have Original Medicare.

Under Original Medicare, the government pays directly for the covered health care services you receive. A key benefit is your ability to see any doctor (including specialists) or hospital that takes Medicare. Most do.

According to the Kaiser Family Foundation, only 1 percent of doctors don’t participate in Medicare. The report that 83 percent of primary care physicians accept new Medicare patients.

Key Pros of Original Medicare

• You are covered anywhere in the country.
• When you need care, you can see any doctor or hospital that accepts Medicare.
• There is NO need to get prior permission/authorization from Medicare or a doctor.
• You don’t have to worry about your doctor leaving a plan’s ‘network’.
• Some people will pay a premium for Part A.
• Most everyone will pay a monthly premium for Part B.
• There typically will be a co-insurance that you’ll pay for each service you receive.
• Medicare imposes limits on the amounts that doctors and hospitals can charge for your care.

Key Cons of Original Medicare

• Prescription drug coverage is not included and you’ll need a private plan (stand alone Part D).
• The federal government sets the premiums, deductibles and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services).
• Under Part B, you are responsible for 20 percent of a doctor visit or lab test bill.
• If you want prescription drug coverage with Original Medicare, in most cases you will need to sign up and pay for a stand-alone Medicare drug plan.
• You are not covered outside of the United States.

Type 2. Original Medicare + A Medigap Policy

Some 14 million Americans have Original Medicare plus a separate Medigap policy (2022).

Medigap is the word most people use for a Medicare Supplement policy. First Medicare pays it’s share for covered health care costs. Then the Medigap plan will pay its share. This will cut down (or reduce to zero)  your out-of-pocket costs for things like coinsurance, copayments and deductibles.

You must have Medicare Part A and Part B (Original Medicare) to qualify for a Medigap plan.

Insurance companies. There are different plans identified by letters (example Medigap Plan G is the most popular among those turning age 65).

Depending on where you live, there may be a few plans available, or as many as 20. While plans offer uniform benefits rates vary. A Plan G is a Plan G. But one can cost twice as much because the insurance companies pick what they want to charge.

Pros of Medigap Coverage

Type 3. Medicare Advantage (Part C)

Some 27 million Americans have Medicare Advantage (Part C) coverage (2022).

Medicare Advantage plans (also called Part C) are not really provided by Medicare. That surprises many. They are provided by insurance companies (UnitedHealthcare or Aetna) or health providers (Kaiser).

These are often the plans you see aggressively advertised on television.

Medicare Advantage (MA) plans can work well for many seniors. A 2021 study in the Journal of the American Medical Association found that MA enrollees often receive more preventive care than those in traditional Medicare.

But if you have chronic conditions or significant health needs, you may want to think twice. For one thing, with Original Medicare you can see any provider that accepts Medicare, which is most of them. Many MA plans will require you stay within a specific network.

And with MA plans you may face some significant charges. For example, your out-of-pocket costs can be $8,300 (in-network care) or $12,450 (in- and out-of-network care combined).

Here are Some Pros for Medicare Advantage

• There may be no cost with some plans.
• Many plans now offer some prescription drug coverage.
• Some offer benefits not in Original Medicare, such as fitness classes, some vision and dental care.
• You can switch plans annually during certain set times.

And, here are Some Cons

• Who you are able to see (doctors) can be limited by your plan.
• The plan may require approvals to see specialists.
• Your coverage does not travel with you.
• There can be high out-of-pocket maximums.
• Your plan benefits change annually.

Type 4. Medicare Stand-Alone Prescription Drug Plan (Part D)

If you have Original Medicare and take drugs consider a stand-alone Part D plan.

The Association has a great deal of information on selecting the best Medicare drug plan coverage. We encourage you to learn more. There is even access to an online tool that can help you compare currently available plans.

Find Agents To Discuss 4 Types of Medicare Coverage

Click here to find Medicare insurance agents near me

The Association makes available the leading national directory that lists Medicare agents selling Medicare Advantage and Medigap plans.

It is free to access. And 100 percent private.

Simply enter your Zip Code to see the directory listing.

Additional Medicare Information You May Find Of Value

Please click on any of the links (below). Read other recent news stories or reports containing information we believe you may find of value.

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