Medicare Options at a Glance

Everyone’s healthcare needs are different. When you become eligible for Medicare, choosing between your various options can be tricky. One option may require you to see providers in the plan’s network, and others, while more expensive, may contain more coverage and/or let you see any provider you choose. Understanding the the pros and cons of each option will help you get the best care for the lowest price. This side-by-side comparison of your Medicare options is a great way to get started on your Medicare Journey.


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 - $1,632**
For Part B - $240

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 $8,850****

Plans K - $7,060
Plan L - $3,530

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 $174.70 in 2024******

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 $70 to as high as $300 in 2024*******

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********

*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 $408 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 $816 per day (up to 60 days in a lifetime).

*** Medicare allows up to $545 maximum deductible in 2024 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 $8,850, 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 Part D premiums, copays, deductibles for 2024, please visit our Medicare Costs page.

******To see Medicare premiums, copays, deductibles or 2024, please visit our Medicare Costs page.

*******To see Medigap plans, copays and deductibles, please visit our Medicare Supplement page

********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.

ADDITIONAL MEDICARE DISCLAIMERS: 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 your options.

The above information on Medicare costs was retrieved from Medicare.gov.

Pathway Health Insurance Experts, nor it’s agents, are not part of the Federal Government Medicare System. The content in on this page has not been reviewed or approved by Medicare.