Medicare 101: The five types of plans to think about during open enrollment

Oct 27th, 2021 | By | Category: News

Open enrollment for 2022 Medicare health insurance runs until Dec. 7., and for Washington’s 1.3 million Medicare beneficiaries, the process can be confusing—especially when it comes to choosing the right plan.

As a first step, it’s important to know the different types of Medicare health insurance. These include Original Medicare, Medicare Advantage, Supplemental (Medigap) and Zero Cost plans. Additionally, qualified health plans are also available to Washingtonians of any age.

Let’s dive into what these different terms mean.

Original Medicare

The most widely known type of plan, Original Medicare is available to most individuals over the age of 65 and those under 65 with certain disabilities. It doesn’t include supplemental benefits like dental coverage or gym membership. This plan is offered in three parts: Part A or hospital insurance, which covers various kinds of inpatient medical care; Part B or medical insurance, which covers medically necessary and preventive medical care, and Part D, which covers prescription drugs. The three parts must be bought individually and are billed separately. Original Medicare doen’t have an out-of-pocket maximum, which means there is no limit to how much you could pay in medical expenses per year.

Original Medicare may be for you if you are comfortable without an out-of-pocket maximum and want to shop individually for areas of your health coverage such as dental, vision, and medications.

Medicare Advantage

Similar to Original Medicare, but it has enhanced benefits, a single-member card, a monthly premium, and an out-of-pocket maximum to ensure a yearly cap. Unlike Original Medicare, Medicare Advantage isn’t divided into separate pieces. This plan covers parts A (hospital insurance) and B (medical insurance) of Original Medicare plan, in addition to prescription drug coverage, vision care and preventive and comprehensive dental coverage. It also has enhanced benefits like fitness resources, meals delivered after hospital stays, and rides to medical appointments. You use one card to access services and pay one monthly premium (if your plan has a premium).

Medicare Advantage plans are available in Washington to anyone who qualifies for Original Medicare. Depending on your income and health needs, Medicare Advantage plans can cost less while covering more services.

Supplemental Plans (Medigap)

This is an optional supplement to Original Medicare. Individuals who have Medicare parts A and B can purchase this plan. Medigap covers what Original Medicare doesn’t, such as medical coverage outside of the United States. If you’re happy with Original Medicare but want help paying for some of the health care costs that Original Medicare doesn’t cover, this may be a good choice for you.

Zero-cost

This type of Medicare Advantage plan has no a monthly premium. The coverage depends on the type of plan. If you don’t get sick often, it could be worth exploring a zero-cost plan.

Qualified health plans

These are available individuals of all ages through a federal or state health insurance marketplace and provide certified health benefits under the Affordable Care Act. There are three types–Bronze, Silver, and Gold, with different percentages of the cost that they cover. Each level covers medical, hospital, and prescription drugs, and has an out-of-pocket maximum. However, this plan doesn’t cover dental, vision, or enhanced benefits.

If you’re not eligible for Medicare, you may be eligible for a qualified health plan. But if you already have Medicare, it’s illegal for anyone to sell you one.

It’s important to know your options while Medicare health insurance plans are open for enrollment. From now until Dec. 7, you can join, switch, or drop a Medicare plan and explore options. Help with the process is available from medicare.gov, ncoa.org (National Council on Aging), and private insurers.

 

Source: Community Health Plan of Washington.

 

ONLINE RESOURCE FOR MAKING MEDICARE CHOICES 

The National Council on Aging (NCOA), an advocacy organization for older adults, has an online resource to help people make Medicare coverage choices during Open Enrollment.

At ncoa.org/age-well-planner/medicare is information such as cost estimates, (premiums, deductibles, and co-pays) plan options, and advice from NCOA-approved advisors.

“Choosing a Medicare plan that doesn’t cover what you need can be costly—for your health and for your budget,” said NCOA president Ramsey Alwin. “People with Medicare should reevaluate their coverage every year to make sure it still fits their health care needs. Open Enrollment is a limited annual opportunity to match your needs when it comes to cost, coverage, convenience, and customer service.”

Medicare Open Enrollment runs through Dec. 7 for coverage that takes effect in 2022.

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