Understand your Medicare coverage options.
Learn more about your Medicare coverage options.
Getting started with Medicare.
Whether you’re turning 65 or just need to understand more about the basics of Medicare, Wellcare can help.
Understanding the basics means understanding your choices.
With so many Medicare coverage options to choose from, you may wonder where you should start. The chart below will help you learn more about the A, B, C, and Ds of Medicare.
Original Medicare
Part A
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
Original Medicare
Part B
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Medical Equipment
- Surgery
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Tests & Surgery Deductible
Medicare Advantage Plans
(Part C)
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Tests & Surgery Deductible
Prescription Drug
(Part D)
- Inpatient Hospital Care
- Nursing/Hospice Care
- Exams
- Outpatient Visits
- Lab Tests/Imaging
- Surgery
- Medical Equipment
- Wellness Services
- Routine Vision
- Routine Hearing
- Prescription Drugs
- Hospital Care Deductible (Part A)
- Tests & Surgery Deductible (Part B)
Original Medicare: Parts A & B
Original Medicare is managed by the federal government and is just a starting point for your health care.
Part A covers in-patient medical hospital care, nursing facilities, hospice, and some home health care.
Part B helps cover doctor visits, outpatient care, and some preventive services.
- You usually pay a monthly premium and must meet yearly deductibles
- Covers 80% of the approved amount and you’re responsible for the remaining 20%
- Most prescription drugs, hearing aids, and routine dental care are not covered
- No limit on yearly out-of-pocket costs
Medicare Advantage: Part C
Medicare Advantage is offered by private insurers and combines the benefits of Parts A & B plus vision, dental, and hearing benefits and much more.
- Maximum out-of-pocket limit per plan year means 100% of allowed healthcare costs after you meet your out-of-pocket limit
- Helps you control and understand your financial risk
- Some plans include Part D (prescription) coverage, fitness memberships, and FREE over-the-counter health care items
Understanding the Value of Medicare Advantage plans.
When it comes to understanding the value of Medicare Advantage plans, you may have questions. Wellcare is here to help from the start. Learn more about your Medicare options in this quick video.
Common Types of Medicare Advantage Plans
Health Maintenance Organization (HMO)
- Usually requires you to get most care and services from in-network providers
- Costs are lower with in-network providers
- Must choose a primary care provider (PCP)
- Need referrals to see a specialist
Preferred Provider Organization (PPO)
- Provide you with a preferred network
- Costs are generally higher with out-of-network providers
- Don’t need to choose a PCP
- Probably won’t need a referral to see a specialist
Dual Special Needs (D-SNP)
- Designed to coordinate covered benefits and services if you qualify for both Medicare and Medicaid.
Medicare Advantage and Prescription Drug Coverage: Part D
If you rely on prescription drugs to maintain your health, you have several options for prescription drug coverage:
- Some Medicare Advantage (Part C) plans include prescription drug coverage (MAPD)
- If you have Original Medicare (Parts A&B), you can purchase a Prescription Drug Plan (PDP)
- You can also choose a Medicare Advantage plan with Part D prescription coverage (MAPD)
- Includes mail-order service to help you save money and time
- You may need to pay a deductible
Stages of Coverage
-
Deductible:
The amount you pay before a plan covers your prescription drug costs, if applicable.
-
Initial Coverage:
The plan pays its share of the cost, and you pay your share. This stage lasts until your payments and the plan’s payments total $4,660 for the year.
-
Coverage Gap:
Begins when your drug costs and plan payments for the year reach $4,660. You will pay 25% of the cost for covered generic and brand-name drugs until your out-of-pocket costs for the year reach $7,400.
-
Catastrophic Coverage:
If your out-of-pocket costs for prescription drugs reach $7,400, you will pay either 5% of the cost of the drug, a co-pay of $4.15 for generic drugs, or a co-pay of $10.35 for all other drugs, whichever is greater.