Medicare Plan Options
If you don’t need a lot of health care, Original Medicare may be your best option. If you need extra coverage, Medicare Advantage Plans provide additional benefits like vision, hearing, dental and often prescription drug coverage. If you would like a little extra help with your Original Medicare plan, a Medicare Supplemental Insurance Plan is a good choice. You can get prescription drug coverage through a Medicare Part D plan. Medicare and Medicare Advantage don’t cover long-term health care services.
Original Medicare is the basic plan available to all Americans aged 65 and older or anyone who has a disability. Part A covers hospitalizations, hospice care, skilled nursing facilities and home care. Medicare Part B includes doctor’s visits, durable medical equipment, preventative services, medically necessary services, mental health coverage and clinical research. Under Original Medicare, you’ll pay a deductible and then your share for an inpatient or an outpatient visit. There are no out-of-pocket limits on Original Medicare. If you want prescription drug coverage you’ll need to choose and pay for a separate Part D plan.
Medicare Advantage Plans
Medicare Advantage Plans include Original Medicare’s Parts A and B but add extra coverage like hearing, vision and dental. Many plans also offer prescription drug coverage, but not all do. Medicare Advantage Plans come in four types: HMOs, PPOs, Private Fee-For-Service Plans (PFFS) and Special Needs Plans (SNP). You can only select a Medicare Advantage Plan that’s available in your county in Maryland. Even if you prefer a plan in a different county you cannot choose it. If you move, you’ll need to enroll in a new plan. These plans have different premiums and fee structures than Original Medicare.
Medicare Prescription Drug Coverage Plans
While Original Medicare doesn’t cover prescription drugs, you can add a Part D plan for a separate fee. The cost depends on factors like the pharmacy you use, the drug’s “tier” and if financial assistance is available from a drug company to help you pay for its product. Most Medicare Advantage Plans include prescription drug coverage, but not all do. If you don’t enroll in a Part D plan when you’re first eligible for Medicare, or if you aren’t covered through a Medicare Advantage Plan, you can enroll later but may have to pay a penalty.
Supplement Insurance Plans
Worried your Original Medicare doesn’t provide quite enough coverage but there isn’t a Medicare Advantage Plan that you like available in your county? Consider a Medicare Supplemental Insurance Plan. Also known as Medigap, it covers copays for Parts A and B, as well as any excess Part B charges. (It does not, however, cover the $148 Part B premium.) A Medicare Supplemental Insurance Plan can also provide medical coverage if you travel outside the country for personal or business reasons. Medigap does not work with any Medicare Advantage Plan.
Medicare in Maryland by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|921,171||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Maryland
Medicare can be an effective way to save money on health care as long as you understand your plan’s rules and aren’t surprised by unexpected costs or services that aren’t covered. If you need assistance in understanding how Medicare works, reach out to some of these agencies in Maryland to help you make informed decisions.
State Health Insurance Assistance Program (SHIP)
Maryland’s SHIP program can provide objective, unbiased and free assistance for you, your family members or your caregivers if you’re eligible for Medicare. The volunteer, trained counselors at SHIP, which include community educators and Part D prescription plan researchers, can assist your efforts to find the right Medicare plan. They’ll also answer your questions about Medicare Advantage, Medicare Supplemental Insurance Plans or Medicare Part D. If you’re eligible, SHIP counselors can also enroll you in financial aid programs that assist with Medicare copays and premiums.
Contact Information: Website | 410-767-1100
Senior Medicare Patrol (SMP)
The Senior Medical Patrol fights abuse and fraud that can endanger Medicare beneficiaries in Maryland. This includes confidential assistance for seniors about identity theft, fraud, waste or errors in Medicare coverage. Comprised of trained volunteers, the SMP offers educational programs in communities around the state. If you suspect fraud or abuse in your Medicare coverage, you can contact members of the SMP directly.
Contact Information: Website | 800-243-3425
Senior Prescription Drug Assistance Program (SPDAP)
Established by the state in 2005, the Senior Prescription Drug Assistance Program (SPDAP) provides financial assistance to eligible, moderate-income seniors to help cover the cost of Medicare premiums and Part D prescription drug fees. Eligible seniors must have lived in Maryland for at least six months, be enrolled in Medicare and have an income at or below 300% of the Federal poverty level.
Contact Information: Website | 800-551-5995
Medicare Savings Program
If you’re a low-income Marylander and you’re enrolled in Medicare, you may be eligible for one of the state’s Medicare Savings Programs. Medicaid sponsors these programs. They include the Qualified Medicare Beneficiary (QMB), the Specified Low-Income Medicare Beneficiary (SLMB), the Qualifying Individuals (QI) and the Qualifying Disabled Working Individuals (QDWI) programs. If you’re eligible, they’ll help cover the costs of Medicare premiums, copays or deductibles. To be eligible, you must meet limits on assets and income.
Contact Information: Website | 800-638-3403.
Learn More From Our Sources
- HHS.gov | What is Medicare Part C? | Last accessed June 2021
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Part D | Last accessed June 2021
- Medicare | Health Maintenance Organizations (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organizations (PPO) | Last accessed June 2021
- Medicare | Private Fee-for-Service Plans (PFFS) | Last accessed June 2021
- Medicare |Special Needs Plans (SNP) | Last accessed June 2021
- Medicare | How to Get Prescription Drug Coverage | Last accessed June 2021
- Patient Advocate Foundation | Understanding Drug Tiers | Last accessed June 2021
- Maryland Health Care Commission | Consumer Guide to Long Term Care | Last accessed June 2021