Understanding how all the parts of Medicare work is an important factor in ensuring a smooth Medicare journey. Comparing your options side-by-side is a great way to get started on selecting the best possible coverage for your needs!
Original Medicare | Medicare Advantage | Medigap | |
Type of Coverage | Provided and managed by Federal Government | Provided and managed by private carriers contracted with Medicare | Sold by private carriers approved by Medicare |
Providers/Referals | Any provider who accepts Medicare Nationwide, no referral needed | Predetermined Network and you may need a referral to see a specialist | Any provider who accepts Medicare Nationwide, no referral needed |
Coverage | Parts A (Hospital) & B (Medical) | Part C (combines A & B into one plan) (replaces your Original Medicare) | Pays 50% to 80%, and in many instances 100% of the costs not covered by Original Medicare* |
Deductibles | For Part A - $1,600** | Varies per carrier, from ZERO to having a separate deductibles for medical care and prescription drugs*** | N/A |
Copays | Beneficiary pays 20% of approved services (after deductible) | National average $20 per doctor visit, $75 for ER or Urgent Care, copays vary for prescriptions based on drug tiers, generics range from $3-$5 | N/A |
Out-of-Pocket Maximums | None | Average can range from ZERO to $8,300**** | Plans K - $6,940 |
Prescription Drugs, Dental, Vision, Hearing | Not part of Original Medicare Parts A & B***** | Some plans include these ancillary benefits | Not covered under Medigap |
Average Premiums | Most people Part A is free, Part B rate is $164.90 in 2023****** | Each company sets its own rates Average of $25 + Part B standard rate | Rates vary based on age and where you live, national mo. average $70 to as high as $275 in 2023******* |
Medical Underwriting | None | You can’t be turned down or charged more because of a health condition during initial open enrollment | Applies only if you miss your initial open enrollment period and do not qualify for a special enrollment******** |
*Also covers skilled nursing facility and foreign travel. Medigap cannot be purchased if you have Medicare Advantage. The majority of Medigap plans do not cover the Part B deductible of your Original Medicare, and per Medicare, Plans that do cover the Part B deductible (F & C) cannot be offered to new beneficiaries enrolling in Medicare.
** For Medicare Part A there is no coinsurance until you have reached your 60th day of hospitalization in each benefit period. Then you pay $400 per day until the 90th day. If you are in the hospital longer than 90 days, you can pay the full bill yourself or use your lifetime reserve days at $800 per day (up to 60 days in a lifetime).
*** Medicare allows up to $505 maximum deductible in 2023 for Prescription Drug coverage, however, half of all Medicare plans have a much smaller or ZERO deductibles for Part D. Keep in mind, these plans may have higher premiums as a trade-off.
****Unlike Original Medicare that has no maximum out-of-pocket (MOOP), the good thing about Medicare Advantage is you pay nothing for covered healthcare once you hit your annual MOOP. While some MA plans (about 20%) set the MOOP at the maximum allowed by Medicare at $8300, many other carriers choose to have a much lower or no MOOP.
*****You will need to enroll in a separate Medicare Part D drug plan. To see Part D premiums, copays, deductibles for 2023, please visit our Medicare Costs page.
******To see Medicare premiums, copays, deductibles or 2023, please visit our Medicare Costs page.
*******To see Medigap plans, copays and deductibles, please visit our Medicare Supplement page
********You are entitled to the lowest possible rate if you act during the initial open enrollment period. After that, unless you qualify for special enrollment, you will have to go through underwriting and may not get the best rate.
Disclaimers:
While Medicare premiums are the same in many states across the US, rates can and do vary in other states. The content above represents national averages, and some parts were retrieved from Medicare.gov.
Northwest General, nor it’s agents, are not part of the Federal Government Medicare System. The content in on this page has not been reviewed or approved by Medicare.
I/We do not offer every plan available in your area. Any information I/we provide is limited to the plans I/we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.