Case Study

Jack has the freedom to see any doctor that accepts Medicare.

He has coverage for inpatient hospital stays, but must meet a Part A deductible of $1,484 for each benefit period.

Jack also has coverage for doctor visits, but must meet Part B deductible of $203 and pay the 20% of the remaining balance of each bill.

Prescription drug coverage is not included. This would require an additional fee.

There is no annual out-of-pocket maximum to protect Jack from hospital or medical bills.

Like many people, Jack might choose to avoid Option 1 because it does not provide prescription coverage and can leave him exposed hospital and medical bills not covered by Parts A or B.

Medicare Supplement plans allow Jack to see any provider in the US that accept Original Medicare.

No referral needed at anytime.

With Plan G benefits, 100% of Jack's Part A (hospital) expenses and 100% of his Part B (medical) expenses are covered after meeting his $203 Part B deductible.

With Part D (prescription) benefits, Jack will have a small copay for generic prescriptions after meeting a $445 calendar year deductible.

Medicare Supplement plans generally do NOT include extra benefits, so Jack might have to find a separate policy to help with dental, vision, etc.

HMO (health maintenance organization) plans require Jack to stay in network with a specified provider list - usually consisting of local providers.

HMO plans also require him to receive a referral from his primary care doctor to see specialists or any other provider.

Jack will receive annual evidence of coverage detailing the potential costs for his hospital and medical services. According to this summary, Jack should not exceed his annual out-of-pocket maximum of $3,500 this year.

With Part D (prescription) benefits, Jack does not have a prescription deductible and will have a small copay for generic prescriptions and a larger copay for brand name prescriptions.

Medicare Advantage plans include extra benefits so Jack will have access to policies like dental, vision, and hearing - as well as a gym membership.

PPO (preferred provider organization) plans require Jack to stay in network with a provider list, but generally have a larger network list than HMO plans. For example, a PPO would allow Jack to see an in-network doctor in a different city, while an HMO would not.

PPO plans do NOT require him to receive a referral from his primary care doctor to see a specialist or any other provider.

Jack will receive annual evidence of coverage detailing the potential costs for his hospital and medical services. According to this summary, Jack should not exceed his annual out-of-pocket maximum of $5,000 this year.

With Part D (prescription) benefits, Jack does not have a prescription deductible and will have a small copay for generic prescriptions and a larger copay for brand name prescriptions.

Medicare Advantage plans include extra benefits so Jack will have access to policies like dental, vision, and hearing - as well as a gym membership.