Pick A Plan Medicare | MyHealthcareFinances

What are some important words to know?

Monthly Premium

The amount that you pay for health insurance, which is usually billed monthly.
You must pay the premium each month, even if you don’t visit a health care provider or use any other healthcare service.

Annual Deductible

The amount you must pay for covered medical care or prescription drugs before your insurance plan starts to pay.
Usually, covered costs are added toward your deductible during your plan year and then start over the next year.

Co-payment (Co-pay)

A fixed dollar amount you pay when you receive medical care or prescription drugs.

Co-Insurance

A percentage of your covered healthcare costs that you pay.
Co-insurance usually only applies after you have reached your deductible.

Out-of-Pocket Maximum

A fixed dollar amount that is the most that you will have to pay for your covered medical care and prescription drugs out-of-pocket during the year.
Once you reach your out-of-pocket maximum, your insurance pays 100% of your covered medical costs for the rest of the year.
Generally, all payments for in-network services count toward your out-of-pocket maximum. This does NOT include your monthly premiums.

Additional Information

For a closer look at health insurance financial terms and prescription drug terms, visit the “Words that Matter for Health Insurance” page (https://www.myhealthcarefinances.com/health-insurance#WordsThatMatter)

Medicare Overview

Medicare is a government-funded and run health insurance program for eligible individuals.

To be eligible you must be:

65+ years old and eligible for Social Security retirement benefits
OR have collected Social Security Disability Insurance (SSDI)* more than 24 months
OR have been diagnosed with end stage renal disease (ESRD) or ALS

*The Social Security Disability Insurance (SSDI) program provides financial assistance to people with disabilities. SSDI pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes.

The Parts of Medicare

What it Is

What it Covers

Part A

Hospital Insurance

Hospital care, skilled nursing facilities, hospice, and home health services

Part B

Medical Insurance

Services from doctors, preventative care, out-patient care, lab tests, mental health care, ambulance services, and durable medical equipment

Part C

Medicare Advantage

Part C is an alternative to Part A & B and it includes the benefits and services covered under Parts A & B, and usually Part D.

Part D

Prescription Drug Coverage

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, like drugs to treat cancer or HIV/AIDS.

Part A + Part B are referred to as Original Medicare

Additional Information

For more information, please visit the “Medicare, Medicaid, and other Government Healthcare Programs” page (https://www.myhealthcarefinances.com/health-insurance#GovernmentInsurance)

What are some different Medicare coverage options?

There are 2 “Lanes” You Can Take for Medicare Coverage

Original Medicare

Part A

Hospital Insurance

Part B

Medical Insurance

Do You Want to Add Prescription Drug Coverage?

Part D

Prescription Drug Coverage

Do You Want to Add Supplemental Coverage?

Medicare
Supplemental Insurance

(Medigap plan)

Medicare Advantage Plan

Part C

Combines Part A, Part B, and usually Part D

Please note

Most Medicare Advantage plans cover prescription drugs. If you are enrolling in a Medicare Advantage plan and want prescription drug coverage, make sure the plan includes prescription drug coverage or purchase a Medicare Part D plan.

If you join a Medicare Advantage plan you can’t buy a Medicare Supplemental Insurance (Medigap) policy

A Medigap plan is a supplemental insurance plan, sold by private insurance companies for those who choose Original Medicare (Parts A and B) that will help pay for “out-of-pocket” costs for care under Parts A and B (not D) such as deductibles, co-payments, and co-insurance amounts.
You will pay an additional monthly premium for a Medigap plan.
Medigap plans are standardized, meaning every health insurance company offers plans lettered A-N, with the same basic benefits, but the premiums and deductibles vary by plan.
If you buy a Medicare Advantage (also called Part C) plan, you are not eligible to buy a Medigap plan.

Tips for Picking a Health Insurance Plan

Here are 3 questions to ask when picking a health insurance plan:

What will the plan actually cost me?

Are my doctors and other health care providers included in the plan’s network?

Does the plan cover my prescription drugs?

What Will the Plan Actually Cost Me?

When comparing plans, it can be tempting to choose the plan with the lowest monthly premium.
However, to figure out how much the plans may actually cost you by the end of the year, you will want to do some math.
On the following screens we will walk you through a few examples to show you how to do this!

Doing the Math to Compare Options

Jamie is about to begin 1 year of chemotherapy treatment, which costs $10,000 per month and is covered by Medicare Part B. Jamie wants to know what plan to choose for the lowest out-of-pocket costs.

Jamie's 3 main options through Medicare are:

Original Medicare

Part A

Hospital Insurance

Part B

Medical Insurance

Jamie Does the Math for
Original Medicare:

Part B Monthly Premium

($202.90 x 12 months) =

$2,434.80

Part B Deductible

$283

Co-insurance

[($10000 x 20%) x 12 months]=

$24,000

Total Annual Cost

$26,717.80

Original Medicare + Medigap

Part A

Hospital Insurance

Part B

Medical Insurance

Medicare
Supplemental Insurance
(Medigap plan)

Jamie Does the Math for Original Medicare + Medigap

Part B Monthly Premium

($202.90 x 12 months) =

$2,434.80

Medigap Monthly Premium*

($300 x 12 months=

$3,600

Part B Deductible

$283

Co-insurance

(The Part B 20% Co-insurance is paid for by the Medigap plan G)

Total Annual Cost

$6,317.80

*This is an estimate for what a Medigap Plan G would cost Jamie, based on where they live.

Medicare Advantage

Part C

Combines Part A, Part B, and usually Part D

Jamie Does the Math for Medicare Part C

Part B Monthly Premium

($202.90 x 12 months) =

$2,434.80

Part C Monthly Premium †

$83 x 12 months) =

$996

Part C Out-of-pocket-maximum

$4,758

Total Annual Cost

$8,188.80

†This is an estimate for what a Part C plan would cost Jamie, based on where they live.

Based on Jamie’s situation, after doing the math, Original Medicare + Medigap Plan G turns out to cost Jamie the least for the year. Even though there is an additional premium for the Medigap plan, it can potentially save Jamie thousands of dollars in out-of-pocket costs. As you can see, it’s important to do the math to see which option is right for you!

This example is based on 2026 Medicare costs.

Additional Things to Consider When Picking a Health Insurance Plan

There are some other things to think about when looking at the cost of a plan:

What will the plan actually cost me?

Understanding Deductibles:

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost.
Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

This is especially important when thinking about a Medigap or Medicare Advantage Plan

Are my doctors and other health care providers included in the plan’s network?

After you have looked at the cost of a plan, you should check if your doctors and other health care providers are in the plan’s network

Original Medicare is Fee For Service

This means you can go to any provider across the country who accepts Medicare.
A Medicare Advantage Plan has a specific network of providers who are covered by the plan.

In-network vs Out-of-network

Many plans will not cover medical care that you receive from an out-of-network provider.
Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out of pocket.

Plan Type

Medicare Advantage plans may offer you multiple types of plans.
For example, you may have the choice between an HMO and a PPO. Typically, PPOs cost more than HMOs, but you have more choice and control with receiving medical care.
It may be helpful to consider the trade-off between flexibility and additional costs!

Does the plan cover my prescription drugs?

If you want prescription drug coverage, the final step is to make sure the plan you choose covers any prescription drugs that you are taking.

If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket for your medications.
This is especially important when comparing Medicare Part D plans, or prescription drug coverage through a Medicare Advantage Plan.

Additional Information

For more information about these topics, including worksheets to help you compare your own plan options – visit TriageHealth.org/HealthInsurance

Additional Information

Additional Information

Hospital Insurance

Medical Insurance

Prescription Drug Coverage

Do You Want to Add Supplemental Coverage?

(Medigap plan)

Combines Part A, Part B, and usually Part D

Please note

Jamie's 3 main options through Medicare are:

Hospital Insurance

Medical Insurance

Jamie Does the Math for Original Medicare:

Hospital Insurance

Medical Insurance

Medicare Supplemental Insurance (Medigap plan)

Jamie Does the Math for Original Medicare + Medigap

Combines Part A, Part B, and usually Part D

Jamie Does the Math for Medicare Part C

Additional Information

Jamie Does the Math for
Original Medicare:

Medicare
Supplemental Insurance
(Medigap plan)