When it’s time to retire, it’s also time to start thinking about Medicare coverage. Before selecting a Medicare plan, we recommend that you look at all the options available to you! Our advice is to pick the best choice based on you and your health and lifestyle needs. We’ll help you out by breaking down a few options for Medicare coverage and what you need to know when you retire.

Option #1: Original Medicare only

Original Medicare includes Part A (hospital stays, skilled nursing facilities, hospice) and Part B (visits to doctors, specialists and urgent care centers and preventive services). But you should know that Original Medicare only covers 80 percent of your Part B expenses. This means you are responsible for the remaining 20 percent, which can add up, especially since Original Medicare has no maximum out-of-pocket (MOOP) limit.

Option #2: Original Medicare + a Medicare Prescription Drug Plan (Part D)

Original Medicare does not cover prescription drugs. This means if you have prescription drug needs, you should enroll in a Medicare Part D prescription drug plan – or a Medicare Advantage Plan with Part D coverage, but we’ll touch on that a bit later! Part D plans are offered by private insurance companies, and they may require that you pay a monthly premium. The premium amount varies by plan. This means that with Option #2, you may be responsible for two premiums each month – your Part B and Part D premiums.

Option #3: Original Medicare, Medigap + a Medicare Part D plan

Like we said before, Original Medicare only covers 80 percent of your Part B expenses. You can purchase a Medicare Supplemental Insurance, also known as Medigap, to cover the remaining 20 percent. Medigap plans are offered by private insurance companies and work alongside Original Medicare to cover some of what it doesn’t pay. The typical rule of thumb with Medigap plans is that you purchase a policy that meets your budget and coverage needs, and the more coverage you want, the higher your premium will be. Also, you cannot combine a Medigap plan with a Medicare Advantage plan.  

Medigap plans do not cover prescription drugs, so you’ll also need to purchase a separate Part D prescription drug plan. This means you may be paying three premiums each month – your Part B premium, your Part D premium and your Medigap premium. It also means you’ll need to carry three cards – your Medicare card, a Medigap card and a prescription drug card. Medigap plans also do not include dental, vision or hearing coverage or other supplemental benefits like over-the-counter (OTC) allowances and health and wellness benefits like gym memberships. You have the option to purchase additional plans to cover dental, vision and hearing services.  

Option #4: Medicare Advantage

Medicare Advantage plans cover the same things as Medicare Part A and Medicare Part B – you just have your coverage through a private health insurance company (like ApexHealth) that contracts with Medicare. All Medicare Advantage plans are reviewed and approved by Medicare.

A Medicare Advantage plan will include hospital and health insurance, prescription drug coverage (in most cases) and additional supplemental benefits that may include dental, vision, hearing and more! You’re responsible for paying your Part B premium, and some Medicare Advantage plans offer premiums as low as $0! There’s also a limit to how much you pay out of pocket each year. This amount is set annually by the Centers for Medicare and Medicaid Services (CMS), but plans have the option of setting a lower amount. Another benefit to Medicare Advantage plans – convenience! Your coverage is all-in-one with one premium for your health insurance coverage along with one card.

We understand that you still probably have a question or two. ApexHealth is happy to help – giving you the advice and guidance you need, wherever you are in the Medicare process. Talk to an ApexAssistant today about your Medicare options when you retire. Give us a call at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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