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Medicare plans: Creating your ideal coverage

March 27, 2023
Medicare Health Insurance Basics
3 MINUTE READ

One of the trickier parts to Medicare is understanding what parts can be combined to create your ideal coverage. Generally, there are two main paths you can choose. From there, you can fine-tune your choices to fit your budget and lifestyle.

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Medicare can be complicated. Choosing a plan can sometimes feel like being lost without a map. At Blue Cross and Blue Shield of North Carolina, we're here to guide you so you can find the plan that works best for you. When it comes to Medicare coverage, there are generally two paths you can take: Original Medicare plus Medicare Supplement and a standalone prescription drug plan, or Medicare Advantage.

First, let's look at path one. In path one, you choose to add Medicare Supplement and Medicare Part D to Original Medicare. This is because Original Medicare wasn't designed to cover all your medical costs alone. Medicare Supplement plans are offered by private insurers like Blue Cross NC. They cover coinsurance, deductibles, or charges greater than the amount allowed by Medicare. Think of it as insurance that helps protect you from unexpected costs. Next, many people buy a standalone drug plan to ensure they have prescription coverage. If you choose not to have prescription coverage, you may have to pay a penalty from the federal government. These standalone prescription drug plans are offered by private insurers like Blue Cross NC. If you want vision or dental coverage, you can add these standalone plans as well. 

Now let's take a look at path two. In path two, your coverage is bundled into one, easy-to-manage Medicare Advantage plans. Blue Medicare Advantage plans include the same coverage as parts A and B, but with extra benefits. Most include prescription drug coverage, and some may include benefits or allowances for dental and vision, low or no-cost gym memberships, hearing aid discounts, and post-discharge meal plans. Medicare Advantage also has an out-of-pocket cap. Once you hit the cap, the plan pays 100% of the covered costs, not you.

Each plan has its benefits, depending on your needs. Path one allows you to see any Medicare-accepting provider nationwide. This is a great option for those who travel often or who prefer this flexibility. Path two provides the convenience of all-in-one coverage under one plan. Many Medicare Advantage plans also offer coverage at a lower overall cost than path one. By using doctors and hospitals within the network, the plan is able to pass on additional savings to you.

Whatever your needs, there's a Blue Medicare plan for you. With a Blue Medicare plan from Blue Cross NC, you can choose confidently, knowing you're backed by the strength of our network and supported by local customer care specialists across our state. To learn more about Blue Medicare, visit us at medicare.bluecrossnc.com.

Path 1: Original Medicare (Parts A & B) + Supplemental Coverage

Part A: This coverage is provided by the federal government and includes several important benefits:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Part B: This part is provided by the federal government with a premium based on monthly income. It includes other benefits that expand your coverage:

  • Physician services
  • Ambulance services
  • Mental health care
  • Durable medical equipment
  • Some preventive service

Supplemental coverage: This coverage is provided by private insurance companies, like Blue Cross and Blue Shield of North Carolina (Blue Cross NC). There are two plans that are considered supplemental:

  • Medicare Supplement Plan: Helps cover the costs not fully covered by Medicare Parts A and B.
  • Part D (Medicare PDP): Helps cover your prescription drug costs.

Path 1 perks

  • Nationwide coverage: Your coverage is good coast-to-coast at any Medicare-accepting provider.
  • Flexibility: You have the freedom to travel and see any doctor or hospital that accepts Medicare.
  • International travel benefits: Some plans offer coverage for emergency care while traveling outside the country.

Path 2: Medicare Advantage (Part C)

Medicare Advantage plans are PPO or HMO plans offered by private insurance companies, including Blue Cross NC. This path includes the following benefits:

  • Medicare Parts A and B: Coverage for all the same services as Medicare Parts A and B, but with lower out-of-pocket costs when you use doctors and hospitals in the plan’s network. (Your Part B premium is still required.)
  • Part D (Medicare Rx): Most Medicare Advantage plans include Part D prescription drug coverage.

Some Medicare Advantage plans also include other valuable benefits to support your overall wellness:

  • Vision benefits
  • Hearing benefits
  • Dental benefits
  • Wellness benefits and discounts such as no-cost fitness memberships

Path 2 perks

  • All-in-one coverage: You can choose a plan that includes prescription drug coverage, as well as other benefits such as dental and hearing.
  • Limits on out-of-pocket costs: Unlike Original Medicare, Medicare Advantage plans put a cap on your out-of-pocket costs. Once you hit the cap, the plan pays 100% of your covered costs.
  • Affordability: Many plans offer more comprehensive coverage for a lower cost than path 1 listed above.

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