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Medicare

How is Medicare Different?

Medicare is a little different than health care insurance plans that you’ve had before. Explore the differences and what it means for you.

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What Makes Medicare Different?

Choosing the right coverage is important, especially as you approach 65. Unlike traditional employer-provided plans that include medical, prescription drug, dental and vision coverage, Medicare is structured differently.

Understanding these differences ensures you select the coverage that meets all your health needs. Medicare has specific parts that cover various services, and knowing what each part covers will help you make informed decisions about your health insurance. 

Medicare Supplement Insurance (Medigap)

Medicare’s basic coverage includes hospital and medical benefits from Part A and Part B but doesn't cover everything. Medicare Supplement Insurance Plans fill in the gaps, covering the 20% that Medicare doesn’t.

Learn More About Medicare Supplement Insurance Plans

Prescription Drug Plans

For medication coverage, consider a prescription drug plan.

Learn More About Medicare Prescription Drug Plans

All-in-One Medicare Advantage Plans

For comprehensive coverage similar to what you had before, a Medicare Advantage plan is a good option. These plans cover medical, hospital benefits of Parts A and B, prescription drugs and may include dental and vision care. All benefits are in one plan, so you don’t have to manage multiple plans.

Learn More About Medicare Advantage Plans

Medicare Compared To Traditional Insurance Plans

Medicare and traditional insurance plans differ in several key aspects.

  Traditional Health Insurance Medicare
Eligibility
  • Typically provided through employers or purchased individually
  • Eligibility criteria may vary depending on the plan and insurer
  • Available to individuals age 65 and older, certain younger people with disabilities, and people with end-stage renal disease (ESRD)
Coverage
  • Includes employer-sponsored plans, individual plans, and marketplace plans
  • May cover hospitalization, doctor visits, prescription drugs, and other services
  • Consists of several parts:
    • Part A (hospital insurance)
    • Part B (medical insurance)
    • Part C (Medicare Advantage)
    • Part D (prescription drug coverage)
  • Beneficiaries can choose between Original Medicare (Parts A and B), a Medicare Advantage plan, a Part D plan, or a Medicare Supplement Insurance plan
Costs
  • Costs vary widely depending on the plan, employer contributions, and coverage options
  • Generally, individuals pay premiums, deductibles, copayments, and coinsurance
  • Most who are enrolled in Medicare Part A do not pay a premium if they or their spouse paid Medicare taxes while working
  • Part B, Part C (Medicare Advantage), Part D, and Medicare Supplement Insurance require a premium payment
  • Some Part C plans have premiums as low as $0
  • Deductibles, copayments, and coinsurance may apply depending on the plan
Provider Networks
  • Often have provider networks, and coverage may depend on whether the provider is in-network or out-of-network
  • Original Medicare and Medicare Supplement Insurance plans allow beneficiaries to see any healthcare provider that accepts Medicare
  • Medicare Advantage plans often have provider networks
Prescription Drug Coverage
  • May or may not be included, depending on the specific insurance provider and plan
  • Part D provides prescription drug coverage, which is optional and can be added to Original Medicare or included in a Medicare Advantage plan
Additional Benefits
  • Coverage and benefits vary widely depending on the specific plan and insurance provider
  • Some plans may offer additional benefits such as dental, vision, and wellness programs
  • While Medicare offers comprehensive coverage, there may be gaps such as dental, vision, and long-term care services
  • Some Medicare Advantage and Medicare Supplement Insurance plans offer additional benefits beyond what Original Medicare covers

Helpful Tools and Resources

 

Help Me Choose a Plan

Not sure whether a Medicare Supplement Insurance Plan or a Medicare Advantage Insurance Plan is right for you? Just answer a few questions to help you decide.

Download the Decision Guide

Stay With Blue℠

If you currently have employer coverage through BCBSTX, explore how you can stay with the insurer you know and trust.

Learn How to Stay With Blue℠
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Get Help from an Agent

Fill out a simple form and a BCBSTX authorized agent will contact you within two business days. You’ll get the personalized help you need to find the right insurance plan for you.

Request an Agent
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Get Your Free Medicare Booklet

Unsure about Medicare options? Our guide can help. Learn about different plans, get clear answers and make an informed decision.

Request a Booklet

Questions? Let Us Help.

Whether you're new to Medicare and need help shopping for a plan or you already have Medicare and want to switch to another plan, we're here to help.

Call us to learn more.

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