Which parts of Medicare do you need? What do they cover? How much do they cost? How do you get coverage? Many people have these same questions, and in this blog series, we are taking a closer look at Medicare to make it easier for you to navigate the journey.

We’ll cover Part A and B — also known as Original Medicare — as well as Medicare Advantage coverage (Part C), Medigap plans and prescription drug coverage (Part D). We’ll also address how and when you should sign up for Medicare and how to help a loved one understand their Medicare options.

If you feel like you’re swimming in a sea of alphabet soup when you’re navigating the Medicare system, you’re not alone. In our last blog post, we covered some basics of Original Medicare — also known as Part A and Part B, or “standard” Medicare.

According to medicare.gov, Original Medicare’s Part B generally covers 80 percent of medical costs, but what if you need more coverage than it provides?

If you don’t have sufficient insurance coverage, you could be risking your retirement savings on Medicare costs. Enrolling in a Medicare Part C plan is one way to boost your coverage for medical care.

Medicare Part C falls into two main options: Medicare Advantage plans and Medicare Supplement plans (also called “Medigap” plans). Unlike Original Medicare, both “cap” or limit what you may have to pay out of pocket for health care. They also cover many of the services that are not covered by Original Medicare.

Some Medicare Advantage plans have valuable extra benefits — such as fitness memberships and dental coverage — while Medicare Supplement plans give you the extra freedom to see any provider in the country that accepts Medicare.

When Can You Get Medicare Advantage?

To enroll in a Medicare Advantage plan, you must be eligible for Original Medicare. For most people, the election time for Medicare Part C is during Medicare’s Annual Enrollment Period (Oct. 15 – Dec. 7).

You should also be aware of several time periods for joining and managing your enrollment in a Medicare Part D plan:

This Medicare video may help you better understand the Medicare Part D enrollment periods.

Medicare Advantage Plans

Medicare Advantage plans include Part A and Part B coverage, but give you even more benefits. Medicare Advantage plans are offered by private insurance companies, like Highmark, and cover costs that Original Medicare doesn’t.

Additional benefits offered by some Medicare Advantage plans include:

  • Vision
  • Dental
  • Prescription drugs
  • Gym memberships

If you join a Medicare Advantage plan, you will still have Medicare Part A and Part B. Your Medicare Part A and Medicare Part B coverage, however, will come from your Medicare Advantage plan, not Original Medicare.

There are several different types of Medicare Advantage plans. The most common are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans.

  • Medicare Advantage HMO and PPO plans give you coverage that’s similar to the private health insurance you may already know, if you’ve been covered by an employer or bought insurance on your own through healthcare.gov.
  • With an HMO Medicare Advantage plan, you must choose your doctors and hospitals from a specific list of medical providers — unless it’s an emergency, in which case you can seek care at the nearest facility.

If you have a PPO Medicare Advantage plan, you will save money by using doctors within your plan’s specific network and pay more for services provided by out-of-network professionals. Highmark has several Medicare Advantage options, including Community Blue Medicare HMO* with lower premiums.

Medicare Supplement Plans (Medigap)

A Medicare Supplement policy, also known as Medigap, is different from a Medicare Advantage plan. It supplements your Original Medicare benefits, whereas Medicare Advantage plans provide new benefits. Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Medigap is sold by private insurance companies, like Highmark. This type of plan can help pay some health care costs that Original Medicare does not cover, including copayments, coinsurance and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then, your Medigap policy pays its share.

Things to Consider When Choosing a Medicare Part C Plan

It is important to think about how you plan to use your health care coverage in order to make the best decision for your health and your wallet. Before you choose a Medicare Part C plan, you should ask yourself the following questions.

  • Do you visit the doctor often? If you do, consider a plan with predictable monthly premiums and lower deductibles and lower doctor-visit copayments.
  • Do you travel often? If so, you may want to consider the flexibility of a PPO Medicare Advantage plan that has a broad network or a Medicare Supplement plan.
  • Do you take prescription drugs often? Consider a Medicare Advantage plan that includes prescription drug coverage or add a Part D plan to either your Original Medicare or Medicare Supplement coverage.

A Medicare Advantage plan can save you money in addition to helping you lead a healthier life. If you’re interested in having plan coverage for things like vision care, hearing aids, podiatry visits and even fitness programs, a Medicare Advantage plan may be right for you.

*Community Blue Medicare HMO is a limited network plan. If you want access to Highmark’s full provider network, including UPMC hospitals and physicians, you may wish to consider our Security Blue HMO and Freedom Blue PPO Medicare Advantage products.

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