What to know about health Insurance after turning 65

Medicare health insurance plans are now open for enrollment for the 1.4 million Medicare beneficiaries in Washington. Deciding what type of Medicare plan is best for you can be a confusing task when not informed of all the important coverage details. Learn more about the different Medicare options available for folks 65 and over in these guidelines.

Different types of Medicare plans

Original Medicare

What does it cover? Original Medicare (OM) 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:

Part A, or hospital insurance, covers various kinds of inpatient medical care

Part B, or medical insurance, covers medically necessary and preventive medical care.

Part D insurance covers prescription drugs.

The three parts must be bought individually and are billed separately. OM does not have an out-of-pocket maximum, which means there is no limit to how much an individual could pay in medical expenses.

Who should get it?

People who are comfortable without an out-of-pocket maximum and want to shop for individual areas of health coverage such as dental, vision, and medication.

Medicare Advantage

What does it cover? Medicare Advantage (MA) performs similarly to the Original Medicare plan; however, it has enhanced benefits, a single-member card, monthly premium, and an out-of-pocket maximum to ensure a yearly cap. Unlike the OM plan, MA is not divided into separate pieces.

This plan covers parts A and B of the Original Medicare plan in addition to:

Prescription drug coverage

Vision care

Preventive and comprehensive dental coverage

Enhanced benefits like fitness resources, meals delivered after hospital stays, rides to medical appointments, and more

Who should get it? MA is available to anyone who qualifies for Original Medicare. Depending on income and health status, MA plans can be more cost-effective while covering a larger array of services.

Supplemental Plans, aka Medigap

What does it cover? Medigap is an optional supplement to OM. Individuals who have Medicare parts A and B can purchase this plan. Medigap covers instances that OM doesn't, such as medical coverage outside of the United States.

Who should get it? Those who have OM and want assistance paying for health care costs that it does not cover.

Zero Cost Plans

What does it cover? This is a type of MA 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.

Who should get it? For an individual who does not get sick often, but still wants some type of coverage this could be a plan for you.