Types of Medicare Plans

En español | Do you know that there are different ways you can get your Medicare health and prescription drug coverage? You can choose Original Medicare. This is the traditional fee-for-service plan provided by Medicare. Or, you can choose Medicare Advantage (also known as Part C).

You can also get Medicare prescription drug coverage to help cover some of the costs of your prescription drugs. AARP’s Medicare Question and Answer Tool is a starting point to guide you through the different Medicare plans.

Q: What are the different parts of Medicare?

A: There are different parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). — Read Full Answer

Q: What is Original Medicare ?

A: Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows beneficiaries to go to any doctor or hospital that accepts Medicare, anywhere in the United States. Medicare will pay its share of the charge for each service it covers. You pay the rest, unless you have additional insurance that covers those costs. Original Medicare provides many health care services and supplies, but it doesn’t pay all your expenses. — Read Full Answer

Q: Does Original Medicare automatically include Part A, Part B and Part D?

A: You get Part A and Part B of the Original Medicare plan when you’re automatically signed up for Medicare. To get drug coverage under Original Medicare, you must choose and join a Medicare-approved Part D private drug plan. — Read Full Answer

Q: How do I enroll in Original Medicare?

A: It's easy if you receive Social Security retirement benefits: The Social Security Administration will automatically enroll you in Medicare when you turn 65. If you are under 65 and get disability benefits, the Social Security Administration will enroll you in Medicare after you have received benefits for 24 months. — Read Full Answer

Q: What is Medicare Advantage?

A: Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare. Medicare Advantage plans are sold by Medicare-approved private insurance companies and must cover the same health care services as original Medicare (except hospice care).  — Read Full Answer

Q: Do Medicare Advantage plans include both Part A and Part B?

A: Medicare Advantage plans must include both Part A and Part B. — Read Full Answer

Q: Where do I find information about the Medicare Advantage plans in my area?

A: Medicare Advantage plans are available in most parts of the United States. To begin your search for a plan, use the Medicare Plan Finder at www.medicare.gov/find-a-plan, or contact your local State Health Insurance Assistance Program (or SHIP) at www.shiptacenter.org. — Read Full Answer

Q: How are Medicare Advantage plans different from Original Medicare?

A: The private plans operate differently from original Medicare in several ways. - Read Full Answer

Q: I have a Medicare Advantage plan. Do I still need Medigap insurance?

A: If you have a Medicare Advantage plan, you cannot buy a Medicare Supplement Insurance or Medigap plan. — Read Full Answer

Q: Do Medicare Advantage plans provide the same coverage as Original Medicare?

A: Medicare Advantage plans cover all Medicare-covered services and must include both Part A and Part B benefits.— Read Full Answer

Q: How do I find the best plan for me?

A: Before you choose a Medicare Advantage plan, consider carefully the many options these plans offer. Begin by asking yourself the following questions. — Read Full Answer

Q: Is enrollment in a Medicare Advantage plan automatic or do I need to enroll directly with the plan?

A: Medicare doesn’t automatically enroll you in a Medicare Advantage plan — you need to choose a plan and sign up directly. — Read Full Answer

Q: What are my options if my Medicare Advantage plan is ending at the end of this year?

A: If your Medicare Advantage plan is ending at the end of the year, you can join another Medicare Advantage plan or enroll in original Medicare.— Read Full Answer

Q: If I  have problems with my Medicare Advantage plan, can I switch plans?

A: You can change plans or join original Medicare once a year during the annual open enrollment period, from Oct. 15 through Dec. 7, and your new coverage will begin Jan. 1 of the following year.  — Read Full Answer

Q: How are Medicare Advantage plans different from each other?

A: In 2017, most Medicare beneficiaries can choose from a variety of plans from at least six insurance companies. The plans may have different provider networks, cover different drugs at different pharmacies, and can charge different monthly premiums, annual deductibles, and copayments or coinsurance for hospital and nursing home stays, and other services.  — Read Full Answer

Q: How do I enroll in a Medicare Advantage plan? 

A: You must first enroll in original Medicare and then switch into the separate Medicare Advantage program, which is an alternative to original Medicare.  — Read Full Answer

Q: What is Medicare Part D?

A: Medicare Part D drug coverage is sold by private insurance plans that set their own premiums, prescription prices and other charges that can vary from plan to plan. — Read Full Answer

Q: What is the Part D “doughnut hole” or coverage gap and how does it work?

A: In the initial phase of Part D coverage, you pay roughly 25 percent of the plan's cost for the drug. When you and the drug plan have paid a total of $3,700 for drugs in 2017, you enter the coverage gap or doughnut During this second phase, you will pay no more than 40 percent of the plan's price for a brand-name drug and 51 percent for a generic drug. — Read Full Answer

Q: Is it just prescription drug costs that count toward reaching the doughnut hole or all medical costs?

A: Only the amount you and your Part D plan have paid for covered drugs determines when you reach the coverage gap. — Read Full Answer

Q: How will I know if I’ve reached the coverage gap?

A: You should receive a monthly statement from your plan showing your total out-of-pocket costs for covered prescription drugs and indicating if that amount puts you in the coverage gap or takes you out. — Read Full Answer

Q:  When is the doughnut hole going to close?

A: The coverage gap or doughnut hole will gradually narrow, if the current law continues as scheduled, until in 2020 and beyond you will pay no more than 25 percent of the cost of any covered drug in the doughnut hole. — Read Full Answer

Q: When does the doughnut hole go away?

A: The Medicare Part D doughnut hole will gradually narrow until it completely closes in 2020. — Read Full Answer

Q: After the doughnut hole is closed, will I still pay 25 percent of my prescription drug costs?

A: Once the doughnut hole is closed in 2020, you will pay approximately 25 percent of the cost of your prescriptions until you reach the last phase or catastrophic coverage level. — Read Full Answer

Q: I think I am going to continue to spend a lot on drugs even after the doughnut hole closes. Will there still be catastrophic coverage even after the doughnut hole closes in 2020?

A: Yes, the catastrophic phase of the Part D benefit is permanent to help protect those people facing the greatest outpatient drug costs. — Read Full Answer

Q: Do Medicare Advantage plan also have a doughnut hole in their coverage? 

A: The doughnut hole (or coverage gap) is part of the Medicare Part D drug benefit. — Read Full Answer

Q: What is Medigap (Medicare Supplemental) insurance?

A: Medigap or Medicare supplemental insurance is sold by private insurance companies and helps pay some of the health care costs original Medicare doesn’t cover, including some or most Medicare deductibles and coinsurance.  — Read Full Answer

Q: Is Medigap and Medicare Supplemental Insurance the same thing?

A: Yes. Medigap and Medicare Supplemental Insurance are the same thing. — Read Full Answer

Q: Can I have more than one Medigap plan at the same time?

A: By law, Medigap insurers aren’t allowed to sell more than one Medigap plan to the same person. — Read Full Answer

Q: How do I enroll in a Medigap plan?

A: In most states, 10 standard categories of Medigap policies are available — labeled A, B, C, D, F, G, K, L, M and N. — Read Full Answer

Q: What's the important factor in buying Medigap coverage?

A: Probably one of the most critical factors is timing. You have a one-time six-month Medigap open enrollment period that starts the month of your 65th birthday and you are enrolled in Part A and Part B.  — Read Full Answer

Q: Who can buy Medigap policies?

A: Anyone with Medicare Parts A and B can buy a policy, although guaranteed rights apply only to those 65 or older who purchase policies during a specific time period.  — Read Full Answer