Let’s look at the coordination of benefits rules to understand who pays first with Medicare.
Everyone with Medicare has rights and protections regardless of how they get their Medicare. These rights include rights to privacy, rights to appeal, rights to clear information, and protections from discrimination.
Here are some resources for getting help with Medicare including the official Medicare helpline 1-800-MEDICARE.
Original Medicare has no limits on out-of-pocket costs. However, Medicare Advantage plans have out-of-pocket maximums and Medigap plans can limit out-of-pocket costs as well.
To compare Medicare plans you’ll want to compare cost-sharing, networks, additional benefits like vision and dental, and drug plans.
CMS rates the quality of Medicare Part C and Part D plans every year. They provide overall scores for plans, health plan and drug plan scores by category, and more.
Medicare Advantage is part of Medicare, but Original Medicare and Medicare Advantage are different in terms of how provider choice, cost, and coverage work.
There are two ways to get Medicare. Original Medicare (Part A and Part B) and Medicare Advantage (Part C). You can also add a drug plan (Part D).
If you live in Massachusetts, Minnesota, or Wisconsin, Medigap policies are standardized in a unique way.
In Medicare Advantage (Part C) there are different plan types, HMO, PPO, and POS. Each plan type utilizes a different type of network.
There are four Medicare Part D plan benefit types: Defined Standard (DS), Actuarially Equivalent (AE), Basic Alternative (BA), and Enhanced Alternative (EA).
Medicare Part D is prescription drug coverage. Part D is optional drug coverage administered through private companies that can be paired with other Medicare plans.
Medigap (Medicare Supplement) plans are standardized in terms of benefits. You can easily compare Medigap letter plan benefits by referencing the chart below.
Every year HHS and CMS put out a free guide to Medicare called “Medicare & YOU.” They also put out a number of other guides on various aspects of Medicare.
Each part of Medicare has unique cost-sharing amounts. Below are the cost-sharing amounts for Medicare copays, coinsurance, deductibles, and more for Medicare Parts A, B, C, D, and Medigap.
Medicare has a number of different enrollment periods. Initial enrollment, general enrollment, open enrollment, and special enrollment all have unique rules and dates.
Medicare is health insurance for seniors. Medicaid is health insurance for low-income individuals and families.
All part D drug plans have four phases. These phases are the Deductible Period, Initial Coverage Period, Coverage Gap Period, and Catastrophic Coverage Period.
There are four parts of Medicare. Part A (hospital insurance), Part B (outpatient), Part C (Medicare Advantage), and Part D (drug coverage).
There are four main types of Medicare Advantage Plans HMO, PPO, PFFS, and SNP. There are also two less common types, HMOPOS and MSA plans.
Medicare Advantage (Part C) is an all-in-one solution for Medicare that offers at least the benefits of Medicare Parts A and B, and typically Part D, through a private insurer.
Medicare Part A is the part of Original Medicare that provides hospital coverage. Part A covers inpatient care in a hospital, skilled nursing facility care, inpatient care in a skilled nursing facility (not custodial or long-term care), Hospice care, and home health care.
Medicare Part B is the part of Original Medicare that provides medical coverage. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medigap (also called Medigap Supplement) is insurance sold by private companies that helps fill in the gaps in Medicare. Medigap is not part of Medicare.