Woman looking at laptop weighing her medicare options.

Medicare costs: what you can expect to pay

When it comes to choosing the Medicare plan that’s right for you, the options can be overwhelming. We’re here to help explain the differences between Original Medicare, Medicare Advantage plans and Medicare supplement plans, and their associated costs.

Original Medicare

Original Medicare, the federally funded health care program, consists of two parts:

1

Part A

Medicare Part A covers covering inpatient hospital care (hospital care, mental health care, skilled nursing facility care, home health care, hospice care and blood transfusions).

Cost: If you or your spouse paid into Medicare through an employer for 40 quarters, you won't have a premium for Part A. But there are different prices for those who paid in for less than 30 quarters and for 30 to 39 quarters. You will always be responsible for paying deductibles and coinsurance.

2

Part B

Medicare Part B covers outpatient services (doctors’ office visits, outpatient hospital services, ambulance services, outpatient mental health, durable medical equipment, outpatient therapies and outpatient blood transfusions).

Cost: Plan B has a monthly premium that varies based on income, plus deductible and coinsurance costs.

The downside: While it seems Original Medicare covers quite a bit, there will inevitably be gaps in coverage. These gaps include: deductibles and copayments, coinsurance, prescription drug coverage, vision and dental.

In order to fill this gap in coverage, you have some options:

  • Medicare Advantage plans

  • Medigap (also known as Medicare supplement plans)

However, you cannot have both at the same time.

Medicare Advantage plans

Medicare Advantage plans, also referred to as Part C, are offered by private companies — such as Sharp Health Plan and UnitedHealthcare — and not through the government.

These plans are PPOs and HMOs, meaning you choose from a network of doctors and hospitals, and must stay within that network.

Medicare Advantage plans cover everything that Original Medicare covers (inpatient hospital care and outpatient services), but do not cover hospice care. Most Medicare Advantage plans may also cover extras such as prescription drug coverage, vision, dental and wellness programs. Medicare Advantage plans can offer additional benefits for people managing specific chronic conditions.

Medicare supplement plans or Medigap

Medicare supplement plans, also referred to as Medigap, are offered by private companies. Unlike Medicare Advantage, a Medicare supplement plan allows you to go to any doctor or hospital that accepts Medicare.

Just like the name suggests, this plan supplements or covers the gaps left by Original Medicare such as coinsurance, copayments and deductibles. It does not cover prescription drug coverage, so you may need Medicare Part D to help with those costs.

While supplement plans are a little more costly than Medicare Advantage plans, they are more widely accepted and portable — you can take them from state to state, if needed.

Prescription drug coverage or Medicare Part D

If you need prescription drug coverage, then you’ll want to explore Medicare Part D. This supplemental plan adds drug coverage to Original Medicare. Part D is rolled in to most Medicare Advantage plans.

If you have additional questions our Medicare specialists are here to help with free 30-minute phone consultations.

Ready to enroll?

At Sharp, we accept Medicare Advantage plans from both Sharp Health Plan and UnitedHealthcare. To learn more about specific plan options, please select a provider.

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