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MEDICARE OPTIONS COMPARIED

An easy-to-follow guide for those eligible or becoming eligible for Medicare to help them get know their options and make good informed decisions with their Medicare benefits.

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2021

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 – $1,484**
For Part B – $203

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 $7,550****

Plans K – $6,220
Plan L – $3,110

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 $148.50 in 2021******

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 $45 to $118 in 2021*******

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********

Original Medicare

Medicare is the federal health insurance program for people who are 65 or older. The different parts of Medicare help cover specific services.

Medicare Part A (Hospital Insurance)
Part A is automatic and covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.  Most people get Part A for free.
Medicare Part B (Medical Insurance)
Part B is automatic if you do not have other coverage through an employer or spouse. Part B coverage resembles what you may think of as traditional health insurance and covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.

Learn More About Medicare EnrollmentRequest Quote

*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 $341 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 $742 per day (up to 60 days in a lifetime).

*** Medicare allows up to $445 maximum deductible in 2021 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 $7550, 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 Medicare premiums, copays, deductibles or 2021, please visit our Medicare.gov.

*******To see Medigap plans, premiums, copays and deductibles, please visit our Medicare.gov

********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.
Group Benefit Partners is not part of the Federal Government Medicare System. The content in on this page has not been reviewed or approved by Medicare.

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