Options for Medicare Coverage: What It Does and Doesn’t Cover

Medicare is the United States government’s health insurance program for seniors 65 years of age and older. According to the Centers for Medicare & Medicaid Services (CMS), the Medicare system currently has more than 60 million enrolled participants. This health care organization provides its members with a variety of Medicare coverage options to help them maintain a comfortable retirement lifestyle.

Are you prepared to apply for Medicare? If this is the case, continue reading to learn more about the various Medicare alternatives accessible to you so that you may make an informed choice about your future medical care needs. Today, do some homework to safeguard your future.

In a Nutshell, Medicare

Medicare covers its members’ hospital, health specialist, and physician visits in Medicare-accepting facilities. Medicare is a “fee-for-service” plan, which means that members pay a small, up-front price for each service they use. The remainder of the cost will be covered by Medicare.

Options for Medicare Coverage

Medicare provides coverage for a variety of different benefits through a variety of different plans. Each of these plans is designated with a unique letter.

Several of these policies are available through private insurers. These companies work in collaboration with CMS to provide these varied levels of coverage. Certain of these plans may be available just to individuals and not to couples.

All Medicare participants are eligible for two types of basic coverage. These fundamental coverage components are referred to as Medicare Parts A and B. You may hear Medicare Parts A and B referred to as “Original Medicare” because the benefits contained in these two portions were included in the program’s inception in 1965.


Medicare Part A covers the costs of home health care, hospitalization, and some hospice care. To be eligible for Medicare Part A, you or your spouse must have worked for a minimum of ten years. Members of Part A are responsible for a $1,340 deductible every benefit period.

Part B of Medicare covers the costs of medical equipment, diagnostic tests, and doctor visits. Enrollees in Part B pay monthly premiums based on their monthly income. These monthly premium payments typically range between $134 and $428.


Supplemental or “Gap” Insurance Plans

Additionally, Medicare enrollees have access to a network of supplemental coverage options known as Medigap policies.

Medigap policies can cover the medical expenses of a single person. If married partners choose to get Medigap coverage jointly, they must each purchase a separate insurance.

There are now eight Medigap plans available to members to augment the services provided under Parts A and B. Supplemental Medigap policies are denoted by the letters C, D, F, G, K, L, M, and N.

Occasionally, Medicare beneficiaries confuse Medigap insurance with basic Medicare Parts A and B coverage. Occasionally, you’ll hear someone refer to a Medigap plan as a “part,” similar to how “Part A” or “Part B” are titled. Original Medicare components are correctly referred to as “parts,” whereas Medigap plans are referred to as “plans.”

Medicap now offers eight distinct gap plans that cover additional medical treatments not covered by Medicare Parts A-B. Among these Medicare supplemental insurance programs are the following:

C Plan

Plan C gap policies cover additional medical expenses such as routine hearing and vision examinations. Plan C may also cover additional expenses not covered by Parts A and B, such as dental office visits.

Beginning in 2020. Plan C will no longer be available to newly enrolled Medicare beneficiaries. Medicare participants who began their coverage prior to 2020 may continue to sign up for these Plan C benefits. After 2020, no new members will be admitted to the system.

D’s plan

Plan D provides additional coverage for prescription medication costs. Preventative care costs such as flu shots and other common vaccines may also be covered by Part D pharmaceutical plans.

Plan D is a relatively recent Medigap insurance provider, having been founded in 2006. Prior to that, Medicare beneficiaries had to pay for prescription drugs out of pocket.

F and G plans

Beyond Medicare Parts A and B, Plans F and G provide comparable coverage. After Part A and B benefits are exhausted, both Plans F and G cover hospitalization costs for an extra year. Plans F and G can also assist with the cost of other medical services not provided by general practitioners, such as specialist referrals and blood transfusions.

However, when it comes to augmenting Part B expenditures, Plans F and G differ. For instance, Plan G cannot be used to offset the annual deductible amounts associated with Part B. This is a possible application of Plan F.

Additionally, Plans F can assist in covering a variety of other medical care bills. For instance, Plan F can cover the cost of your first three pints of blood transfusion. Additionally, you can use Medigap Plan F to cover medical expenses incurred when traveling outside the United States.

Plan G would also assist you in covering any medical expenses incurred when traveling abroad. Additionally, Medigap Plan G will assist in covering the first $185 in out-of-pocket medical expenses. Ambulance services, diabetes supplies, and x-rays are all examples of out-patient medical services.

K, L, and M plans

Medigap Plans K, L, and M all provide comparable coverage. Each plan only covers a percentage of the expenses not covered by Medicare Parts A and B. Plan K covers 50% of nursing facility co-pays and hospice payments, whereas Plan L covers 70% of these same costs. Plan M assists in covering 20% of these similar costs.

Medigap Plan N Plan N is an additional advantageous option for Medicare subscribers. Monthly premiums are reduced in return for increased co-payments and annual deductibles under Plan N. Plan N may cover up to $20 in co-pays for doctors’ exams and up to $50 in co-pays for emergency department visits.

Medicare Supplemental Insurance Plans

A Medicare Advantage Plan is a supplement to Medigap insurance. You can enroll in a Medicare Advantage plan via a commercial insurance firm that has been authorized by the Centers for Medicare and Medicaid Services (CMS). These businesses operate in the same manner as a health maintenance organization (HMO) or a preferred provider organization (PPO.)

A Medicare Advantage plan reimburses for health care on a monthly basis per enrollee rather than on a per-service basis. Medicare Advantage plans can supplement the coverage provided by Medicare Parts A and B. Additionally, some Medicare Advantage plans include prescription drug charges in addition to routine medical visits for dental and vision exams.

What Is the Difference Between Medicare Advantage and Medigap Plans?
The fundamental distinction between Medicare Advantage and Medigap plans is the manner in which they are paid. Members of Medicare Advantage will pay a standard monthly or billing period premium (whether they use the covered medical service or not.) Members of Medigap pay for medical services only when they utilize them.

Another distinction is the location of medical treatment available to members. Enrollees in Medicare Advantage plans must use doctors and medical facilities within their HMO or PPO network. Members of Medigap plans may see any doctor or institution that currently accepts Medicare.

Consider the Differences Between Medigap and Medicare Advantage Plans
When determining if a Medigap or Medicare Advantage plan is best for you, there are several lifestyle considerations to consider. Consider the following factors to assist you in making your choice:

Medications on Prescription

Members of Medigap insurance will not be covered for prescription medications. To access this benefit, Medigap members must supplement their Parts A and B coverage with Plan D. Medicare Advantage plans, on the other hand, will automatically include coverage for prescription medication expenditures.

Restriction on Medical Service Providers

Medicare Advantage plans operate similarly to PPO or HMO plans. Enrollees in Advantage plans are required to see physicians or specialists who are part of the same Advantage plan networks. Medigap plans offer greater flexibility in that they allow you to see any physician who accepts Medicare.

Medical Emergencies While Traveling Out of Town

Medicare Advantage restricts members’ access to providers who are also members of the same network. This criterion restricts one’s ability to obtain medical treatment while traveling outside of town. Medigap plans do not impose network restrictions on members as long as the provider accepts Medicare enrollees.

Following Steps

Selecting a Medicare plan does not have to be a difficult endeavor. Conduct research today to ensure that you are fully educated about the many coverage options available to you.

To learn more about the many Medicare coverage alternatives available, consult our Medigap plan comparison chart. You’ll find a summary of the advantages included in each plan. Utilize this chart to assist you in developing a strategy for meeting your future medical insurance coverage needs.

Additionally, you can visit your retirement financial planning counselor. You should seek their guidance on the most suitable Medicare plan for your future needs.

Don’t forget to visit our website for additional information about the Medicare process. We want you to appreciate the well-earned milestone for which you have worked a lifetime.