New to Medicare Guide

Every Medicare Advantage (MA) plan includes the same Part A and Part B benefits that Original Medicare provides. In addition, most Medicare Advantage plans also include Part D prescription drug coverage, and many will cover additional benefits like dental, hearing, vision, etc. The important distinction is this:

• You must be enrolled in Part A and Part B before you can enroll in Medicare Advantage.
• Medicare Advantage plans are administered by private insurance companies. This means private insurance carriers are paid to manage Part A and Part B on behalf of Medicare and have the ability to provide added coverage like Part D, dental, hearing, or vision under a single plan.

While the Part A and Part B benefits are equal coverage to Original Medicare, any covered health benefits are limited to a local, provider network.

Medicare Part D is a stand-alone prescription drug coverage plan. Part D is only available through private insurance carriers as optional coverage to expand Original Medicare (Part A and Part B). There is a distinction between adding Part D to Original Medicare and having Part D coverage included within a Medicare Advantage plan:

• If you add a Part D plan to Original Medicare, you will be responsible for the premiums and deductibles of that plan. Though, there are federal assistance programs that help with costs for people that qualify.
• Medicare Advantage plans typically include Part D drug coverage. This can be a cost saver as long as you know your pharmacy and doctor are in-network and the drug is part of the plan’s formulary (a plan’s list of covered drugs).

Pro Tip: If you delay enrollment when first eligible, you may be responsible for a lifetime late enrollment penalty once you enroll later.

A Medigap plan is an insurance to supplement -- or cover gaps -- services not covered by Original Medicare. When you think about your different options, it’s important to know that a Medigap policy can help pay the remaining costs (which is the remaining 20%) not covered by Medicare, e.g., copays, coinsurance, and deductibles.

Like other options that can be added to Part A and Part B, you will be responsible to choose and purchase your Medigap policy, which is administered by private health insurance carriers.

People new to Medicare often confuse Medicare with Medicaid. Medicaid provides free or low-cost health coverage to children, families, pregnant women, the elderly, and people with disabilities. It’s important to know that Medicaid is a dual program run by federal and state resources, but the benefits and/or expansion of Medicaid is at the sole discretion of each state.

Can you have both Medicare and Medicaid at the same time?

Yes. You can be eligible for both Medicare and Medicaid at the same time; it’s called dual-eligibility. In these certain circumstances, Medicare will be the primary insurance and pay first for any costs and services covered under the Medicare plan. For any coverage not covered by Medicare, Medicaid will be the secondary payer and cover those costs.