You have important decisions to make when you’re eligible for Medicare. Be confident in choosing coverage that fits your health care and budget needs.

Get to Know Your Coverage Choices

When looking at coverage choices, there’s a lot to consider. You can enroll in Original Medicare Part A (hospital insurance), Original Medicare Part B (medical insurance), or both. Once you enroll in Medicare, there are more coverage choices you can make. Consider a Medicare Advantage plan (Part C), a Medicare prescription drug plan (Part D), or a Medicare Supplement insurance plan (Medigap) to complete your Medicare coverage.

Original Medicare is provided by the federal government and is made up of Part A, which helps pay for hospital stays and inpatient care, and Part B, which helps pay for doctor visits and outpatient care.

You can choose to add one or both of the following to Original Medicare:

• Medicare Supplement Insurance Plan (offered by private insurers): Helps pay some of the out-of-pocket costs not paid by Original Medicare.
• Medicare Prescription Drug (Part D) Plan (offered by private insurers): Helps pay for prescription drugs

Or, you can choose a Medicare Advantage plan. These plans are offered by private insurers and:

• Combines Part A (hospital insurance) and Part B (medical insurance) in one plan.
• Usually includes prescription drug coverage.
• Offers additional benefits beyond Original Medicare

Original Medicare Coverage

Original Medicare, provided by the federal government, has two parts: Part A and Part B. Original Medicare Part A helps pay for hospital stays, while Original Medicare Part B helps pay for doctor visits.

The following coverage options are offered by private insurance companies.

Medicare Advantage (Part C) Plans

Medicare Part C is known as Medicare Advantage. Medicare Advantage plans cover and combine Original Medicare Part A and Part B benefits into one plan. Most Medicare Advantage plans also include prescription drug coverage (Part D) and offer additional benefits not covered by Original Medicare, often with no additional premium.

• What's Covered

  • The same benefits as Original Medicare Parts A and B (except hospice care, which is still covered by Original Medicare Part A)
  • Most plans cover prescription drugs
  • Some plans offer additional benefits, like:
  • Eye exams, eyeglasses and corrective lenses
  • Dental exams, cleanings and X-rays
  • Hearing tests and hearing aids
  • Wellness programs and fitness benefit

• What's Not Covered

  • Hospice care, which is still covered by Original Medicare Part A
  • Benefits vary by plan

Special Needs Plans (SNPs)

SNPs are Medicare Advantage plans. If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include prescription drug coverage. Some plans also include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four types of Special Needs Plans:

• Dual-Eligible Special Needs Plans (D-SNPs) for individuals who have both Medicare and Medicaid
• Chronic Special Needs Plans (C-SNPs) for individuals living with severe or disabling chronic conditions
• Institutional Special Needs Plans (I-SNPs) for individuals who live in a skilled nursing facility
• Institutional-Equivalent Special Needs Plans (IE-SNPs) for individuals who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility

• What's Covered

  • Types of drugs most commonly prescribed for people eligible for Medicare (decided by the federal government)
  • Specific brand name and generic drugs on the plan's drug list (formulary)

• What's Not Covered

  • Drugs not on a plan’s drug list
  • Drugs prescribed for certain cosmetic or non-medically-necessary conditions (decided by the federal government)
  • Non-prescription drugs
  • Vitamins and supplements (prescription or over-the-counter)
  • Drugs received while an inpatient (these might be covered by Part A)

• What's Covered

  All Medicare Supplemental plans provide these basic benefits:

  • Medicare Part A coinsurance and hospital costs (an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance or copayment
  • Part A Hospice/Respite care
  • Blood (first 3 pints each year)

  
  

  Some plans also provide additional benefits, including:

  • Medicare Part B excess charges*
  • Skilled nursing facility coinsurance or copayment
  • Foreign travel emergency**

   

  NOTE: Benefit and costs vary depending on the plan chosen.

• What's Not Covered

  • Long-term care
  • Routine eye exams or eyeglasses
  • routine hearing test or hearing aids
  • Routine dental exams, cleaning or X-rays
  • Private duty nursing
  • Prescription drugs

Seven Plan Combination Options

Medicare isn't one-size-fits-all. You can combine different plans, offered through the government and private insurance companies, to get the coverage that's a good fit for you. Keep in mind that your health care and budget needs may change over time. When they do, you can be assured there's an option for you.

There are seven different combinations of plans to choose from.

Image description: The seven plan combination options are: Option 1: Original Medicare Part A and/or Part B alone. Option 2: Original Medicare Part A and/or Part B plus a standard prescription drug plan. Option 3: Original Medicare Part A and/or Part B, plus a standalone prescription drug plan, plus a Medicare Supplement (or Medigap) plan. Option 4: Original Medicare Part A and/or Part plus a Medicare Supplement (Medigap) plan. Option 5: Medicare Advantage plan (Part C) plus Part D prescription drug coverage. Option 6: Medicare Advantage plan (Part C) without Part D drug coverage. Option 7: Medicare Advantage Private Fee-for-Service plan (Part C) without drug coverage or a Medicare Savings Account (MSA) plan, plus a standalone Part D prescription drug plan.

Enroll with RMHP

RMHP is here to help! Here’s how you can enroll in an RMHP Medicare Advantage or Dual Special Needs Plan.