You’re automatically enrolled in the government’s Original Medicare program when you first join Medicare, so you may want to consider whether basic hospital and medical insurance is enough for your needs. For additional coverage, such as vision, dental, fitness, and prescription drugs, you may want to sign up for a private insurance plan from Oregon’s Medicare Advantage program. If you stay in Original Medicare, you have the option of adding on a stand-alone prescription drug plan and supplemental insurance to help pay for out-of-pocket costs.
Original Medicare insures you for medically necessary services to diagnose, treat, and prevent illnesses. This coverage is administered in two parts. Part A hospital insurance covers your inpatient stay in a hospital or skilled nursing facility and some home health care services. Part B medical insurance helps pay for visits to a doctor or specialist, blood tests, diagnostic imaging, ambulance, and durable medical equipment, such as wheelchairs. Under Original Medicare, you typically pay monthly premiums, annual deductibles, and coinsurance or copays for services received.
Medicare Advantage Plans
Once enrolled in Original Medicare Parts A and B, you have the option to switch to a Part C Medicare Advantage Plan in your service area, as long as you’re enrolled in Medigap. These plans are available through private insurers under contract with the government and cover the same services as Original Medicare. Medicare Advantage Plans also cover additional expenses, such as eyeglasses, hearing aids, dental care, gym memberships, prescription drugs, and transportation to medical appointments. Insurers have the flexibility to offer any mix of approved benefits. There are four broad types of Medicare Advantage Plans: HMO, PPO, PFFS, and SNP. Premiums, deductibles, and cost-sharing vary by individual plan.
Medicare Prescription Drug Coverage Plans
Medicare Part D refers to prescription drug coverage, which helps pay for the medication a doctor prescribes to treat an illness or condition. Although drug coverage is optional, you may be subject to a penalty if you don’t sign up when you first qualify. This penalty is usually charged as a monthly penalty when you join a drug plan later. You can sign up for drug coverage through some Medicare Advantage Plans or a standalone Part D prescription drug plan that supplements Original Medicare. You must meet your plan’s annual drug deductible before the plan begins paying its portion of your medication. All drug plans must meet a basic level of coverage but may differ in the generic or brand-name drugs they cover, cost-sharing, and pharmacies you can use.
Medicare Supplement Insurance Plans
Original Medicare helps cover a portion, but not all, of your health care expenses. You must still pay deductibles, coinsurance, copays, excess charges, and out-of-country emergency care, for example. Some insurance providers offer Medicare Supplement Insurance, or Medigap plans, to help pay for these out-of-pocket expenses. Medigap plans in Oregon are standardized by letter (A to D, F, G, K to N). Plans within each letter category offer the same coverage to help you better compare policies. You may only enroll in Medigap if you’re receiving Medicare through Original Medicare.