Medicare
Coverage Options
Medicare Part A and Part B (Original Medicare) do not cover all medical expenses. Obtaining additional coverage can help you better manage or reduce your out-of-pocket costs.
Medicare
Coverage Options
Medicare Part A and Part B (Original Medicare) do not cover all medical expenses. Obtaining additional coverage can help you better manage or reduce your out-of-pocket costs.
Your Options
Medicare Advantage
(Part C)
An all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare and are designed to cover everything included in Medicare Part A (hospital) and Part B (medical), often with extra benefits like prescription drug coverage, dental, vision, hearing, fitness programs, and more, all rolled into one plan.
When you enroll in a Medicare Advantage Plan, you still have Medicare, but your coverage and customer service come directly from the private insurance company you choose.
There are different types of Medicare Advantage plans to meet your unique healthcare needs:
HMO (Health Maintenance Organization):
These plans usually require you to use doctors and hospitals in a specific network and often require referrals to see specialists.
PPO (Preferred Provider Organization):
PPO plans give you more flexibility to see providers both inside and outside the network, usually at a higher cost for out-of-network care, and typically don't require referrals.
DSNP (Dual Special Needs Plans):
These plans are designed for individuals who qualify for both Medicare and Medicaid, offering specialized coverage and often extra benefits like transportation, over-the-counter allowances, and meal services.
Chronic Condition Special Needs Plans (C-SNPs):
Tailored to individuals with certain chronic conditions, such as diabetes, heart disease, or COPD, these plans provide focused care management and benefits specific to your health needs.
Additionally, some Medicare Advantage Plans offer a Part B premium giveback, meaning the plan helps pay part (or even all) of your monthly Medicare Part B premium, helping you save money each month.
Prescription Drug Coverage
(Part D)
Is an option for those with Original Medicare, providing coverage for prescription drug costs.
Note: Individuals enrolled in Medicare Advantage plans typically do not need to purchase a separate Part D plan, as prescription drug coverage is often included in Medicare Advantage plans. These are typically used for people with a medigap policy who need insurance for their prescriptions.
Medigap
(Medicare Supplement)
An option for individuals with Original Medicare, covering out-of-pocket costs for health expenses not typically covered by Medicare Parts A and B (Original Medicare). These Plans typically have an additional premium on top of the premium you pay for Medicare part B. For people with underlying health conditions that need to see doctors regularly these types of plans might be seen as the 'more cost effective' option, meaning less out of pocket expenses, but more upfront for the monthly premiums. When in your Initial Enrollment Period, this is the only time you will have access to these policies without having to go through medical underwriting. It is a great choice for people in IEP if you have a chronic health condition and may be denied at a later time due to underwriting.
Note: Those enrolled in Medicare Advantage plans do not need to purchase a Medigap plan. They are two distinct options. If choosing to not go with original Medicare, you have the choice between a Medicare Advantage Plan or a Medicare Supplement
Comparison of Your Options
Plan
Medicare Advantage
(Part C)
Prescription Drug Coverage (Part D)
Medigap
(Medicare Supplement)
Premium
All Medicare Advantage plans require that you continue to pay your Part B insurance premium.
You may also have a separate monthly insurance premium for your Medicare Advantage plan.
Most Part D plans require a monthly premium. These premiums may change each year.
You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
All Medigap plans require that you continue to pay your Part B premium and a separate premium for Medigap coverage.
Deductible
Some plans have deductibles.
Some plans have deductibles.
Some plans have deductibles.
Copays
There may be copayments that apply to specific services.
Many Part D plans require a fixed copayment each time you fill a prescription.
There may be copayments that apply to specific services.
Coinsurance
May apply to specific services.
Some plans require that you pay coinsurance for a medication every time you fill a prescription.
Coinsurance varies depending on the plan.
Coverage Gap
All plans have an annual limit on your out-of-pocket expenses.
Most Medicare Part D plans incorporate a cost-sharing feature commonly referred to as a coverage gap or "donut hole."
The coverage gap represents a temporary threshold wherein you are accountable for covering all of your drug expenses until you reach the plan's annual out-of-pocket limit. Once you reach this limit, you will only be responsible for paying a small portion of your prescription costs for the remainder of the year.
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Macy Insurance Solutions is committed to serving you at the highest level with all your Medicare needs.
National Producer Number: 21305089
DISCLAIMER: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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Macy Insurance Solutions is committed to serving you at the highest level with all your Medicare needs.
National Producer Number: 21305089
DISCLAIMER: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Company
Directories
Legal