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HEALTH INSURANCE INSIGHTS

Review all Medicare costs when comparing plans, including premiums, deductibles, coinsurance, and out-of-pocket costs.

Medicare is a federal health insurance program for people when they reach 65 and for people with qualifying disabilities such as ALS or end-stage renal disease. You can usually choose between multiple Medicare options.

You can go with Original Medicare, add on a Part D prescription benefit plan and choose a Medigap option to help pay for care -- or you can pick a Medicare Advantage policy with supplemental offerings.

One of the important differences between Medicare plans is costs. Original Medicare offers standard costs, while you can find wide varieties among Medicare Advantage plans.

Here are the differences between Original Medicare and Medicare Advantage, how much they cost and how to choose a Medicare plan.

KEY TAKEAWAYS
  • Medicare beneficiaries choose between Original Medicare and Medicare Advantage plans.
  • Factors that influence which plan to pick include costs, quality of care, supplemental benefits, type of plan, provider network, and what’s offered in your area.
  • Medicare Advantage plans generally have premiums and deductibles, but you may be able to find a no-premium plan or one with a low deductible.
  • People with Original Medicare can also get Part D prescription drug benefits and Medicare supplemental coverage to help pay health care costs.

What’s the difference between Original Medicare and Medicare Advantage?

Original Medicare, also called Parts A and B, has been an option from the start of Medicare in 1965:

  • Part A covers hospital stays.
  • Part B handles physician visits, outpatient care, medical supplies and preventive services.

The Centers for Medicare and Medicaid Services (CMS) runs the national program. People with Original Medicare are also eligible for Part D and Medigap. Part D is a prescription drug benefit, while Medigap helps pay for out-of-pocket costs.

Meanwhile, private insurers offer Medicare Advantage plans with CMS oversight. Most people with Medicare have Original Medicare, but that’s changing.

CMS predicts that more than 29.5 million people will have Medicare Advantage in 2023. There will also be more plan options as private insurers plan to expand plan offerings.

UnitedHealthcare and Humana make up the most Medicare Advantage members, but many insurers have grown their Medicare Advantage membership over the past few years.

Almost two-thirds of Medicare Advantage members are in HMOs. About one-third are in PPOs, which have higher premiums, but more flexibility, such as a larger network.

Unlike Original Medicare, you’re not able to add on other types of coverage like Part D to a Medicare Advantage plan. That’s because Medicare Advantage offerings already provide additional coverage within the plan. Supplemental benefits include prescription drugs, vision and dental.

Original Medicare costs

Medicare Part A is free for most Americans -- as long as you paid Medicare taxes for at least 40 quarters. So, if you worked for 10 years and paid Medicare taxes, you won’t have to pay premiums for Part A.

People who didn't pay enough previous taxes pay between $274 and $499 monthly for Part A.

Part A had a $1,556 deductible in 2022 You’ll have to pay for health care services until you reach that deductible if you're hospitalized.

Here's how Part A costs work when you're hospitalized:

  • A deductible and no coinsurance for days 1 to 60 of each benefit period.
  • A coinsurance amount per day for days 61 to 90 of each benefit period.
  • A coinsurance amount per “lifetime reserve day” after day 90 of each benefit period (up to 60 days over your lifetime).
  • All costs for each day after you use all the lifetime reserve days.

Part B cost $170.10 monthly for most Americans in 2022. Also, higher-income people may have to pay higher premiums.

The Part B annual deductible was $233 in 2022, which is $30 more than in 2021 but much lower than most Medicare Advantage plans. Once you reach the deductible, Medicare pays 80% of costs and you pay the other 20%.

Medicare Advantage costs

Medicare Advantage costs vary by state, insurer, plan type and specific offering. The average monthly Medicare Advantage premium is only $19 for 2022. Insurers also offer plans with no premiums. However, you’ll likely pay more out of pocket for those plans when you need health care services.

Medicare Advantage plans vary widely. It’s essential to dig into each plan to find out which one works best for you.

For instance, you may find a plan with higher premiums, but with more supplement benefits. Nearly all Medicare Advantage plans have prescription benefits.

CMS has also expanded insurer Medicare Advantage options. Now, they can offer reimbursements for rides to doctor appointments, meal delivery and adult care services. People with chronic illnesses may also get help for grocery shopping, improved home environments and transportation for non-medical needs.

Medicare Part D cost

You can couple a Part D prescription drug plan with Original Medicare, which doesn’t have prescription benefits.

But the amount you pay for Part D deductibles, copayments, and/or coinsurance varies by plan.

The Medicare.gov website, which is managed by CMS, states that drug coverage costs vary depending on:

  • Your prescriptions and whether they’re on your plan’s list of covered drugs (formulary).
  • What “tier” the drug is in.
  • Which drug benefit phase you’re in (like whether you’ve met your deductible, or if you’re in the catastrophic coverage phase).
  • Which pharmacy you use (whether it offers preferred or standard cost sharing, is out of network, or is mail order).Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less.
  • Whether you get extra help paying your Medicare drug coverage costs.

Medigap cost

Medigap helps pay out-of-pocket costs for people with Original Medicare. There are 10 standardized Medigap plans, which enable you to compare apples-to-apples.

Private insurers offer Medigap policies. These plans pay for co-payments, deductibles and coinsurance, including hospital stays, physician service or prescription drugs.

The cost of Medicare varies, but you can find high-deductible policies under $100 a month. Other Medigap plans, which have lower deductibles, can cost more than $300 monthly.

Medigap premiums can vary by age depending on the plan.

Costs by Medicare plan

Here's a breakdown of monthly premiums by Medicare plan. Make sure you understand the deductible for your specific plan and how that affects out-of-pocket costs. You may find a low-premium Medicare Advantage plan, but it usually has much higher out-of-pocket costs than Original Medicare.

Type of MedicareAvg. monthly premiums
Original Medicare$170.10*
Part DAbout $33
Medicare AdvantageAbout $19
MedigapVaries, as low as under $100 to more than $300 depending on policy

*Medicare Part A is usually free. This is Part B and the most common amount paid. Some people with high income may have to pay more. Medigap costs may vary.

Choosing a Medicare plan

Whether you choose Original Medicare or Medicare Advantage depends on many factors:

  • Plans offered in your state
  • Costs
  • Quality of care
  • Other coverage, such as a spouse’s health plan
  • Provider and hospital network
  • Supplemental offerings
  • Type of plan

A 2019 Insurance.com survey found that Original Medicare received higher marks than Medicare Advantage:

  • 82% of people with Original Medicare gave their plans high scores and no one rated their plan with the lowest rating.
  • 72% with Medicare Advantage gave their health insurance high marks with 7% giving plans the lowest mark.

In our survey, Medicare Advantage received similar marks as employer-sponsored health insurance, which is also offered by private insurers. These plans received much higher marks than individual health insurance plans.

Your first step should be to see if your providers and favored hospitals and facilities are considered in-network. You don’t want to sign up for a Medicare Advantage plan only to find out that your doctor isn’t in-network.

Also, look into the plan specifics. For instance, a health maintenance organization might be a cheaper option but are you OK with only going to providers in a potentially narrow network? You might find a high-deductible health plan with low premiums, but will you have enough savings to help pay deductibles?

CMS offers star ratings for plans. The federal agency rates plans with star ratings that come from membership surveys, quality and performance.

You can use CMS’ Medicare Plan Finder to compare Original Medicare and Medicare Advantage plans.

Costs are a critical piece when deciding on a Medicare plan, but make sure you understand your options before deciding.

Sources:

Disclaimer:
Insurance.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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