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Understand Coverage Gaps

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Original Medicare may leave you with some unpredictable out-of-pocket medical costs due to gaps in the coverage it offers. 

Gaps in Original Medicare

Here we list some of the out-of-pocket costs you may have to pay when you only have Original Medicare Parts A and B.

  • 1. Prescription Drugs
  • 2. Dental
  • 3. Vision
  • 4. Hearing Aids

3 ways to make your coverage more robust than Original Medicare alone

There are a variety of private insurance plans that may help fill the gaps in your healthcare coverage.

All-in-one Medicare Advantage Prescription Drug Plans -

Medicare Advantage Prescription Drug plans combine all the benefits of Original Medicare Parts A and B, and often add benefit options like Part D Prescription Drug coverage and may also include some routine dental and vision coverage, and other extra benefits, all for a single monthly plan premium You must continue to pay your Part B premium.

Stand-alone Prescription Drug Plans (Part D) ¹ -

These plans help cover the costs of prescription drugs, so generally you won’t be responsible for 100% of the cost of covered prescriptions.

Medicare Supplement Plans -

Also known as Medigap insurance, these plans help pay your out-of-pocket costs for Medicare covered medical services.

All-in-one Medicare Advantage Prescription Drug Plans -

Medicare Advantage Prescription Drug plans combine all the benefits of Original Medicare Parts A and B, and often add benefit options like Part D Prescription Drug coverage and may also include some routine dental and vision coverage, and other extra benefits, all for a single monthly plan premium You must continue to pay your Part B premium.

Stand-alone Prescription Drug Plans (Part D) ¹ -

These plans help cover the costs of prescription drugs, so generally you won’t be responsible for 100% of the cost of covered prescriptions.

Medicare Supplement Plans -

Also known as Medigap insurance, these plans help pay your out-of-pocket costs for Medicare covered medical services.

All-in-one Medicare Advantage Prescription Drug Plans -

Medicare Advantage Prescription Drug plans combine all the benefits of Original Medicare Parts A and B, and often add benefit options like Part D Prescription Drug coverage and may also include some routine dental and vision coverage, and other extra benefits, all for a single monthly plan premium You must continue to pay your Part B premium.

Stand-alone Prescription Drug Plans (Part D) ¹ -

These plans help cover the costs of prescription drugs, so generally you won’t be responsible for 100% of the cost of covered prescriptions.

Medicare Supplement Plans -

Also known as Medigap insurance, these plans help pay your out-of-pocket costs for Medicare covered medical services.

What's the difference: Medicare Advantage vs. Medicare Supplement

We break down the differences

Medicare Advantage (Part C)

Medicare Advantage plans combine all the benefits of Original Medicare Parts A and B, and may include your Part D Prescription Drug coverage built right in. Plus, some plans will include routine dental and vision coverage, and other extra benefits, all for a monthly plan premium.

  • Do I Keep My Part A and B Coverage? - Your Medicare Advantage plan will replace your Original Medicare Part A & Part B coverage, but you won’t lose a single benefit. In fact, you may get more. That’s because rather than pay your medical bills directly, the federal government contracts with private insurance companies to administer your plan.
  • How does the plan work to lower my out of pocket costs? - Insurance companies compete for your business with affordable premiums and added benefits. The cost of care will be determined by your plan, and you will no longer be responsible for some out–of–pocket costs outlined by Original Medicare – except your monthly Part B premium. All Medicare Advantage plans include a maximum out of pocket limit which caps your annual out-of-pocket costs, so you'll never be charged more than this total amount for covered care each year.
  • Will I get access to additional coverage and extra benefits? - Prescription drug, routine dental, vision, and hearing aid coverage are included with some Medicare Advantage plans. Just be sure to check the plan you are interested in includes this coverage. You may also have the option to add on additional coverage for more complex dental procedures if your plan doesn’t cover them directly.
  • Will I get to keep my doctor and will I need a referral to see a specialist? - To help manage costs, Medicare Advantage plans usually enter into contracts with a network of doctors and hospitals. That means you’ll generally pay less when you receive care from doctors and specialists who accept your plan. Some plans have large networks of approved doctors and hospitals so be sure to check yours are covered on the plan before you enroll. If you choose an HMO plan you may need a referral to use an in-network specialist, but generally referrals should not be required on PPO plans.
  • What monthly plan premium will I pay? - Medicare Advantage plans generally have a lower premium than Medicare Supplement plans. In fact, many Medicare Advantage plans have no monthly premium at all.
  • When can I enroll? - You can enroll or change plans two times a year. First during the annual enrollment period from Oct 15 – Dec 7 and then again during Open Enrollment from Jan 1 – March 31. From April 1 – Oct 14 you will need to qualify for a special enrollment period to switch plans. If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare
  • Can I change my plan later? - If you want to switch to a different Medicare Advantage or Prescription Drug plan you’ll be able to make that change during the annual enrollment period each year. While you won’t be able to enroll for the first time, if you are already enrolled in a Medicare Advantage plan on January 1st you’ll be able to switch to a different plan during the Open Enrollment Period, which ends on March 31st each year. Outside of that time, you’ll need to have a valid reason to make a change. During these enrollment periods, you have the option to switch back to Original Medicare parts A and B, and if needed, add a Medicare Part D plan.
  • Why would I choose a Medicare Advantage Prescription Drug Plan? - Medicare Advantage Prescription Drug plans may be ideal for people who want an all-in-one plan that will cover f their health and prescription needs in one. There are many Medicare Advantage Prescription Drug plans to choose from so enrollees can ensure they choose the one that covers all the added benefits and services they need to help maintain their health and stay within their budget.
  • Why wouldn’t I choose Medicare Advantage? - Medicare Advantage plans rely on networks of approved doctors and hospitals to keep costs affordable and provide additional benefits. If your doctor is not in your plan’s network of providers, you may have higher costs. Your out-of-pocket costs may be lower if you receive care from in-network providers.

Medicare Supplement Insurance Plans (Medigap)

Medicare Supplement Insurance plans are standardized. They are labeled by letters (A-N). All Health Insurance companies must offer the same basic coverage for each plan. Companies compete for your business based on the monthly premium and other additional benefits beyond this base requirement. Medicare Supplement plans cannot be combined with a Medicare Advantage plan. These plans are separate and you cannot be enrolled in both at the same time.

  • Do I Keep My Part A and B Coverage? - Yes. You keep your Part A and B coverage. Your Medicare supplement plan gets added on to help pay out of pocket costs for covered medical services.
  • How does the plan work to lower my out of pocket costs? - MedSupp helps pay out-of-pocket costs not paid by Original Medicare (Parts A and B), like your part A deductibles and co-insurance. Typically, the higher the plan premium the lower your out- of-pocket "usage" charges will be. With some plans you can offset your monthly premium with a deductible that gets met before the plan covers the rest of your original Medicare expenses.
  • Will I get access to additional coverage and extra benefits? - Medicare supplement plans don’t typically cover prescription drugs or dental, vision, and hearing care. You won’t usually get extra benefits or services with these plans. However, Reliance Medicare offers stand-alone plans you can purchase separately to get this added coverage.
  • Will I get to keep my doctor and will I need a referral to see a specialist? - There are no network restrictions with a Medicare Supplement plan. You may visit any Doctor or hospital of your choosing as long as they accept Medicare patients. You can see specialists without referrals.
  • What monthly plan premium will I pay? - The cost of your premium depends on the plan you choose. Your age, location, sex, and other items may be a factor as well. You must continue to pay your Original Medicare Part B premium as well.
  • When can I enroll? - Medicare Supplement Plans are sold year round. You can apply to buy a Medicare supplement insurance plan any time after you turn 65 and join Medicare Part B - there is no need for a special enrollment period. In many cases, however, pricing will be more favorable if you purchase a plan during your Medigap Open Enrollment Period. This period lasts 6 months after you enroll in Part B.
  • Can I change my plan later? - You can switch or cancel your Medicare Supplement plan at any time for any reason. In some instances, you may be required to go through underwriting for your new Medicare Supplement Insurance plan if you are outside a guaranteed issue right.
  • Why would I choose this plan? - These plans make your costs very predictable. They are great for people who prefer to steadily budget higher premium costs instead of paying each time they use their plan. These plans are also nice for people who want the flexibility to choose any doctor, hospital, or facility they want to use and are able to afford a higher premium in exchange for this flexibility.
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1 https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

2 https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html

3 https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

4 https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html

5 https://www.medicare.gov/coverage/inpatient-hospital-care

6 https://www.medicare.gov/basics/costs/medicare-costs

7 https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

Innovative Financial Group is a licensed representative of Medicare Advantage organization and stand-alone PDP prescription drug plans. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal. Reliance Medicare Helpline is owned and operated by Innovative Financial Group (IFG), a licensed insurance agency. No government affiliation.

 

Reliance Medicare Helpline represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

 

We do not offer every plan available in your area. Currently we represent 6 carrier organizations which offer 2,352 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

 

Innovative Financial Group represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment in the plan depends on the plan's contract renewal.

 

If you are turning 65, otherwise new to Medicare, losing benefits at work, moving, or have both Medicare and Medicaid you may be eligible. Other circumstances may qualify you as well.

 

Costs, coverage, and benefits vary by location. These premiums and benefits may not be available on all Medicare Advantage plans. There may be no plan in your service area that includes all of these benefits.

 

Reliance Medicare Inc. and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate or exclude people because of their race, color, religion, gender, gender identity, sex, sexual orientation, age, disability, national origin, military status, veteran status, genetic information, ancestry, ethnicity, marital status, language, health status, or need for health services. We also provide free language interpreter services. See our full accessibility rights information, non-discrimination disclosure, and language options.

 

Last Update: 11/22/2024

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