What is Medicare?
Medicare coverage options
Medicare comes in four parts:
- Part A — hospital insurance
- Part B — medical insurance
- Part C — Medicare Advantage
- Part D — Medicare Prescription Drug Coverage
Original Medicare includes Part A and Part B. It is administered by the federal government. With Original Medicare, you can see healthcare providers throughout the U.S. who accept Medicare patients.
Part A and Part B do not include:
- Most outpatient prescription drugs
- Hearing aids and exams for fitting them
- Routine vision exams and eyeglasses
- Routine annual physical exams with lab tests
- Dental care and dentures
- Over-the-Counter items
- Long-term care
- Travel outside the U.S. with limited exceptions
- Alternative care, including acupuncture and naturopathic services
- Remote access technology to medical professionals (phone or text)
- Medical transport services (not by ambulance)
With a private insurer, like Moda Health, you can have more. Private insurers offer Part C and Part D.
Part C, Medicare Advantage, is the private option for Part A and Part B. It covers extra benefits that Original Medicare does not. Some of these services may include vision, hearing, dental, and other health and wellness programs.
Medicare Advantage plans limit your out-of-pocket costs for medical services. They have an annual maximum. Once you reach that, you will not pay anything for covered medical services for the rest of the year. Some Medicare Advantage plans have specific coverage areas.
For prescription drug coverage, Medicare Part D, there are two options for you:
- You can enroll in a Medicare Advantage plan that offers prescription drug coverage
- You can join a stand-alone prescription drug plan from a private insurer
You must already have Medicare Part A and Part B to enroll in a Part D option.
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare.
You must have Original Medicare – both Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy.
Comparing Medicare plans
|Features||Part A||Part B||Medicare Advantage
|Medicare Supplement||Prescription Drug
|Also Known As|| Original Medicare
|MedAdvantage MA (Medicare Advantage - no Part D) MAPD (Medicare Advantage Prescription Drug)||MediGap
|Stand-alone Prescription Drug Plan (PDP)|
|Administered through||The Centers for Medicare and Medicaid Services (CMS), a federal agency||Private Insurance companies with contracts with CMS||Private Insurance companies||Private Insurance companies with contracts with CMS|
Usually automatic and no premium required
Must elect coverage and pay additional premium
|Must be enrolled in parts A and B to elect coverage.||Must be enrolled in parts A and B to elect coverage. Cannot be covered on both Medicare Advantage and Medicare Supplement.||Must have Partr A and/or B to elect coverage. Can combine a PDP with Original Medicare, PFFS, MSA or MedSupp, but not MAPD.|
|Benefits||Hospital Coverage||Outpatient Services||Plans may offer a richer benefit than Medicare, and additional coverage that Medicare doesn't cover. See the Medicare Advantage link above for plan details offered through Moda.||Generally covers your out-of-pocket expenses after Original Medicare pays, with some additional covered benefits.||Coverage for Part D drugs. While Moda doesn't offer a PDP, Moda offers combined MAPD plans.|
|Network||Providers must accept Medicare.||Must see participating providers in the MA/MAPD network. HMO (Health Maintenance Organization) plans may require referrals. PPO (Preferred Provider Organization) plans generally have a broader network and include out of network benefits. POS (Point of Service) plans offer out of network benefits. Providers must accept Medicare||Providers must accept Medicare.||Must use participating Pharmacies in the MA/MAPD network|
|Drug Coverage||Limited number of drugs under certain conditions||Included in MAPD plans.||Not covered. Option to buy additional PDP plan.||Covered.|
| Other coverage
(Routine dental, hearing, and vision)
|Not covered.||Usually included.||May be included.||Not covered.|
|Added Benefits and Services||Not included.||May include additional programs and services (such as a fitness benefit) for no cost. Will vary by insurance company.||May include additional programs and services (such as a fitness benefit) for no cost. Will vary by insurance company.||Not covered.|
What Medicare option is right for you?
When you consider your Medicare plan options, you may want to think about the following:
- Your lifestyle, priorities and health needs, including chronic conditions
- Your current coverage. Is it from an employer or retiree plan?
- Prescription drug coverage
- Whether or not you need coverage for services that Original Medicare does not cover
- How often you travel
- Whether or not you live in another state for part of the year
- Out-of-pocket costs
Plans that combine Medicare Part A, Part B, with Part D drug coverage options, and several extra benefits that Original Medicare does not offer.Learn more about Medicare Advantage
Plans that reimburse your Medicare Part A & B cost-shares, and provide limited extra benefits above Original MedicareLearn more about Medicare Supplement
We provide plan member support for Oregon PERS members.
Should you enroll?
You can enroll in Medicare during your initial enrollment period, which is three months before your 65th birthday, your birthday month and three months after. If you are under age 65, you may be able to enroll if you have a qualifying event. Learn more about enrollment and qualifying events. And, find out what to do if you have insurance coverage from an employer.
Last updated Oct. 1, 2023