Submitted by Community Health Plan of Washington.
Open Enrollment for 2022 Medicare health insurance plans starts on October 15 and runs until December 7. For Washington’s 1.3 million Medicare beneficiaries, the process can be confusing—especially when it comes to choosing the plan that’s right for you. That is why we’re walking through the different options available for folks over 65.
As a first step, it’s important to know the different types of Medicare health insurance. These include Original Medicare, Medicare Advantage, Supplemental (Medigap) and Zero Cost plans. Additionally, Qualified Health Plans are also available to Washingtonians of any age.
Now let’s dive into what these different terms mean.
1. Original Medicare
First is the most widely known type of plan, Original Medicare. Original Medicare is available to most individuals over the age of 65 and those who are under 65 with certain disabilities. It does not include supplemental benefits like dental coverage or gym membership. This plan is offered in three parts: 1) Part A or hospital insurance, which covers various kinds of inpatient medical care, 2) Part B or medical insurance, which covers medically necessary and preventive medical care 3) Part D insurance which covers prescription drugs. The three parts must be bought individually and are billed separately. Original Medicare does not have an out-of-pocket maximum, which means there is no limit to how much you could pay in medical expenses per year.
Original Medicare may be for you if you are comfortable without an out-of-pocket maximum and want to shop individually for areas of your health coverage such as dental, vision, and medications.
2. Medicare Advantage
Medicare Advantage performs similarly to the Original Medicare plan. However, it has enhanced benefits, a single-member card, a monthly premium, and an out-of-pocket maximum to ensure a yearly cap. Unlike the Original Medicare plan, Medicare Advantage is not divided into separate pieces. This plan covers parts A (hospital insurance) and B (medical insurance) of the Original Medicare plan in addition to prescription drug coverage, vision care and preventive and comprehensive dental coverage. It also has enhanced benefits like fitness resources, meals delivered after hospital stays, rides to medical appointments, and more. Unlike Original Medicare, Medicare Advantage plans are not divided into separate pieces. You use one card to access services and pay one monthly premium (if your plan has a premium).
Medicare Advantage plans are available in Washington to anyone who qualifies for Original Medicare. Depending on your income and health needs, Medicare Advantage plans can cost less while covering more services.
3. Supplemental Plans or Medigap
Medigap is an optional supplement to Original Medicare. Individuals who have Medicare parts A and B can purchase this plan. Medigap covers instances that Original Medicare doesn’t, such as medical coverage outside of the United States. If you’re happy with Original Medicare but want help paying for some of the health care costs that Original Medicare doesn’t cover, this may be a good choice for you.
4. Zero Cost Plans
A Zero Cost Plan is a type of Medicare Advantage plan that has a monthly premium of $0. The coverage depends on the type of plan that the individual has. At Community Health Plan of Washington, the zero-cost plans of 2022 are Dual Plan, No Rx Plan, and Plan 1. If you want coverage to protect your health but do not get sick often, it could be worth exploring a zero cost plan.
5. Qualified Health Plan
Qualified Health Plans (QHP) are available through a federal or state health insurance marketplace. This plan provides certified health benefits under the Affordable Care Act and is available to individuals of all ages. There are three types, Bronze, Silver, and Gold, with different percentages of the cost that they cover. Each level covers medical, hospital, and prescription drugs and has an out-of-pocket maximum. However, this plan does not cover dental, vision, or enhanced benefits.
If you are not eligible for Medicare, you may be eligible for a Qualified Health Plan. However, if you already have Medicare, it is illegal for anyone to sell you a Qualified Health Plan.
It’s important to know your options while Medicare health insurance plans are open for enrollment. From now until December 7, you can join, switch, or drop a Medicare plan and explore if one of these options is right for you. All of this information can be confusing, but Community Health Plan of Washington Experts are here to help call us at 1-800-944-1247 (TTY Relay: Dial 711) or make an appointment to speak to a Medicare expert in person here: https://forms.chpw.org/medicare-plan-review.
You did a great job in providing detailed explanation about the Original Medicare plan and how to buy each part of it. My husband has to get treatment for his abdominal pain and has been figuring out the best way to cover the expenses. I’ll make sure he considers this option when he consults with an agent later.