Medicare 101: Plans

Medicare 101: Plans

Senior Health | October 14th, 2021

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Health insurance after turning 65? Let’s talk about options.

Open Enrollment for 2022 Medicare health insurance plans starts on October 15. For Washington’s 1.3 million Medicare beneficiaries, the process can be confusing—especially when it comes to choosing the plan that’s right for you.

That’s why we’re walking through the types of Medicare plans available to folks 65 and over.

Did you know? We’re here to help. Our licensed Medicare Experts can answer questions and discuss options with you, by phone or in person. Let’s connect.

What are the different types of Medicare plans?

There are several types of Medicare health insurance:

Additionally, Qualified Health Plans are also available to Washingtonians of any age.

Original Medicare

What is it?

Original Medicare (OM) is available to most people over the age of 65, as well as people under 65 who have certain disabilities.

What does it cover?

Original Medicare is offered in three parts:

  1. Part A, or hospital insurance, covers various kinds of inpatient medical care
  2. Part B, or medical insurance, covers medically necessary and preventive medical care.
  3. Part D insurance covers prescription drugs.

These three parts must be purchased individually and are billed separately. Original Medicare does not have an out-of-pocket maximum, which means there is no limit to how much you could pay in medical expenses per year.

Unlike Medicare Advantage plans, Original Medicare does not include enhanced benefits like supplemental dental coverage or gym membership.

Who should get it?

Original Medicare may be for you if you are comfortable without an out-of-pocket maximum and want to shop individually for areas of your health coverage such as dental, vision, and medications.

Medicare Advantage

What is it?

Medicare Advantage (MA) plans operate the same way as Original Medicare—but with enhanced benefits, a single member card and monthly premium, and an out-of-pocket maximum.

What does it cover?

Medicare Advantage plans cover Parts A and B (hospital and medical/preventive coverage) of Original Medicare. MA plans have out-of-pocket maximums to ensure a yearly cap on what you pay for health coverage.

Many Medicare Advantage plans, including those offered by Community Health Plan of Washington, also provide enhanced or supplemental benefits, such as:

  • Prescription drug coverage
  • Vision care
  • Preventive and comprehensive dental coverage
  • Enhanced benefits like fitness resources, meals delivered after hospital stays, rides to medical appointments, and more

Unlike Original Medicare, Medicare Advantage plans are not divided into separate pieces. You use one card to access services and pay one monthly premium (if your plan has a premium).

Who should get it?

Medicare Advantage plans are available in Washington to anyone who qualifies for Original Medicare. Depending on your income and health needs, Medicare Advantage plans can cost less while covering more services.

Watch this 2-minute video for a recap of the differences between Original Medicare and Medicare Advantage:

Supplemental Plans, aka Medigap

What is it?

Medigap is an optional supplement to Original Medicare. People who have Medicare Parts A and B can purchase Medigap coverage.

What does it cover?

Medigap covers some things that Original Medicare doesn’t, like medical coverage when you’re traveling outside the United States.

Who should get it?

If you’re happy with Original Medicare (OM) but want help paying for some of the health care costs OM doesn’t cover, this may be a good choice for you.

Pro tip: If you’re interested in richer coverage than Original Medicare but cannot afford or commit to a supplemental plan, we recommend considering a Medicare Advantage plan.

Zero Cost Plans

What is it?

A Zero Cost health plan, also known as a zero dollar premium health plan, is a type of Medicare Advantage plan that has a monthly premium of $0.

What does it cover?

Coverage depends on the plan. For example, Community Health Plan of Washington’s zero cost plans for 2022 are our Dual Plan, No Rx Plan, and Plan 1.

Who should get it?

If you want coverage to protect your health, but do not get sick often, it could be worth exploring a zero cost plan.

Qualified Health Plan

What is it?

Qualified Health Plans (QHP) are available through a federal or state health insurance marketplace (also referred to as an “Exchange”)—in WA we have Washington Healthplanfinder.

Qualified Health Plans provide marketplace-certified essential health benefits under the Affordable Care Act. These plans follow established limits on cost-sharing (deductibles, copayments, and out-of-pocket maximum amounts) and are available to people of all ages.

What does it cover?

There are three types (also known as “metal levels”) of Qualified Health Plans: Bronze, Silver, and Gold. The difference between them is the percentage of the cost of care they cover. Each type of plan covers medical, hospital, and prescription drugs, and has an out-of-pocket maximum.

However, a Qualified Health Plan will not cover dental, vision, or enhanced benefits.

Who should get it?

If you are not eligible for Medicare, you may be eligible for a Qualified Health Plan. However, if you already have Medicare, it is illegal for anyone to sell you a Qualified Health Plan.

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