MEDICARE BASICS
How Is Medicare Different?
Medicare is a little different than health care insurance plans that you’ve had before. Explore the differences and what it means for you.
What Makes Medicare Different?
Choosing the right coverage is important, especially as you approach 65. Unlike traditional employer-provided plans that include medical, prescription drug, dental and vision coverage, Medicare is structured differently.
Understanding these differences ensures you select the coverage that meets all your health needs. Medicare has specific parts that cover various services, and knowing what each part covers will help you make informed decisions about your health insurance.
Medicare Supplement Insurance (Medigap)
Medicare’s basic coverage includes hospital and medical benefits from Part A and Part B but doesn't cover everything. Medicare Supplement Insurance Plans fill in the gaps, covering the 20% that Medicare doesn’t.
Learn More About Medicare Supplement Insurance Plans
Prescription Drug Plans
For medication coverage, consider a prescription drug plan.
Learn More About Medicare Prescription Drug Plans
All-in-One Medicare Advantage Plans
For comprehensive coverage similar to what you had before, a Medicare Advantage plan is a good option. These plans cover medical, hospital benefits of Parts A and B, prescription drugs and may include dental and vision care. All benefits are in one plan, so you don’t have to manage multiple plans.
Medicare Compared To Traditional Insurance Plans
Medicare and traditional insurance plans differ in several key aspects.
| Traditional Health Insurance | Medicare | |
|---|---|---|
| Eligibility | Typically provided through employers or purchased individually. Eligibility criteria may vary depending on the plan and insurer. | Generally available to individuals age 65 and older, certain younger people with disabilities, and people with end-stage renal disease (ESRD). |
| Coverage | Offer a variety of coverage options, including employer-sponsored plans, individual plans, and marketplace plans. Coverage may include hospitalization, doctor visits, prescription drugs, and other services depending on the plan. | Consists of several parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Beneficiaries can choose between Original Medicare (Parts A and B), a Medicare Advantage plan, a Part D plan or a Medicare Supplement Insurance plan. |
| Costs | Costs vary widely depending on the plan, employer contributions, and coverage options. Generally, individuals pay premiums, deductibles, copayments, and coinsurance. | Most who are enrolled in Medicare Part A do not pay a premium if they or their spouse paid Medicare taxes while working. Medicare Part B, Part C (Medicare Advantage), Part D and Medicare Supplemental Insurance require a premium payment. Some Part C (Medicare Advantage) plans have premiums as low as $0. Deductibles, copayments, and coinsurance may apply, depending on the plan. |
| Provider networks | Often have provider networks, and the extent of coverage may depend on whether the provider is in-network or out-of-network. | Original Medicare and Medicare Supplement Insurance plans allows beneficiaries to see any healthcare provider that accepts Medicare, while Medicare Advantage plans often have provider networks. |
| Prescription drug coverage | Prescription drug coverage may or may not be included in the plan, depending on the specific insurance provider and plan. | Part D provides prescription drug coverage, which is optional and can be added to Original Medicare or included in a Medicare Advantage plan. |
| Additional benefits | Coverage and benefits vary widely depending on the specific plan and insurance provider. Some plans may offer additional benefits such as dental, vision, and wellness programs. | While Medicare offers comprehensive coverage, there may be gaps in coverage, such as dental, vision, and long-term care services. However, some Medicare Advantage and Medicare Supplement Insurance plans offer additional benefits beyond what original Medicare covers. |
Tools and Resources
Helpful Tools and Resources
- Stay With Blue
- Get Help from an Agent
- Free Medicare Booklet
