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Medicare costs, coinsurance and penalties
Medicare costs, coinsurance and penalties
Save money and delays in coverage by understanding Medicare’s costs, coinsurance and penalties.
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Part A: Hospital Coverage
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|---|---|
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Monthly Premium
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$0 for most people. This is provided you or your spouse paid 40+ quarters (10 years) of Medicare taxes, or received Medicare earlier than age 65 and qualify for premium-free Part A.
If not, you’ll pay up to $506 each month, depending on how long you or your spouse worked and paid Medicare taxes.
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Annual Deductible
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$1,600 for each inpatient hospital benefit period. Note: you might have more than one benefit period a year, depending on how many times you visit a hospital.
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Penalties
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If you don’t enroll in Part A when you’re first eligible (usually when you turn 65), you might have to pay a penalty.
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Did you know?
With Original Medicare, there’s no limit on what you could pay out of pocket. That’s why many people choose supplemental coverage, like a Medicare Advantage plan or Medicare Supplement Insurance.
| Part C: Medicare Advantage | |
|---|---|
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Monthly Premium
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Most plans have $0 or low monthly premiums. (But you must still pay your Part B premium.) |
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Annual Deductible
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Varies by plan |
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Penalties
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None, provided you sign up during one of several official enrollment periods. |
| Part D: Prescription Drug Plan | |
|---|---|
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Monthly Premium
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Varies by plan. You may have to pay more, depending on your income. |
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Annual Deductible
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Varies by plan and pharmacy. |
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Penalties
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If your employer does not offer “creditable coverage,” you have 63 days from your 65th birthday to enroll in a Part D plan to avoid a penalty.
If your employer, union or retiree plan stops offering prescription drug coverage, you can join a Medicare drug plan without penalty as long as you do so within 63 days of the end of your current coverage. |
Something to consider about Part D
Most Medicare Advantage plans include Part D prescription drug coverage.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
Switching Medicare plans
Switching Medicare plans: What you need to know
You probably had good reasons for choosing the Medicare plan you’re on now. But as time goes by, your health, lifestyle and financial picture may change. You should also know that Medicare plan benefits and prescription drug formularies change frequently, too. At some point, you might realize that you need to switch to another Medicare plan.
Check your ANOC
Start by checking the Annual Notice of Change (ANOC) sent by your current Medicare provider each fall to announce important changes to your plan for the upcoming year. Then—
Ask yourself—
Has my health changed over the last year?
Have the plan benefits, deductibles and copays changed?
Are the prescription drugs I’m currently taking on the new formulary?
Is the network of doctors, specialists and hospitals I see still covered?
Is my financial situation likely to change this coming year?
The answers to these questions will determine whether or not you should change plans.
When can you switch?
You can change Medicare plans during any of these three periods:
Annual Enrollment Period (AEP)
October 15 – December 7.
Open Enrollment Period (OEP)
January 1 – March 31.
Special Enrollment Period (SEP)
Based on a variety of lifestyle events.
Switching your Medicare Supplement Insurance
You can change your Medicare Supplement Insurance (Medigap) plan anytime. However, if you apply to change plans, you may have to go through a medical history review (underwriting), depending on which state you live in—unless you qualify for a Medicare guaranteed issue right.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
Working past age 65?
Working past age 65?
Here are a few things to consider:
If you’re planning on working past age 65, you may be wondering whether you should stay with your employer’s health plan or enroll in Medicare. The answer mostly depends on the size of your employer, as well as the cost and coverage of their health plan.
Let’s look part-by-part at how your decision to work past age 65 is impacted by Medicare’s rules.
Medicare Part A (Hospital Insurance)
Most people benefit by enrolling in Medicare Part A at age 65, whether or not they plan to continue working. You pay no premiums, and enrolling as soon as you’re eligible will help you avoid gaps in coverage later.
Medicare Part B (Medical Services)
Depends on the size of the company you work for:
Large Group Employer (20+ employees)
Your employer’s plan is your primary health coverage.
You can delay enrolling in Part B without a late enrollment penalty or lapse in coverage. When you leave your job, you have eight months to sign up for Part B under a Special Enrollment Period.
Word to the Wise
If you work for a large company, compare your current coverage and costs with Medicare. You may find you’re better off staying on your employer’s plan.
Small Group Employer (<20 employees)
Medicare is your primary health coverage, and your employer’s plan is secondary.
This means that your employer’s plan won’t pay for anything covered by Medicare. Because you may pay a penalty if you don’t sign up for Part B when you’re first eligible—and there could be a delay in coverage, too—it’s best to sign up for Parts A, B and D at age 65.
Medicare Part C (Medicare Advantage)
When you do decide to enroll in Medicare, you could opt for a Medicare Advantage plan. Offered by private insurance companies, like Cigna HealthcareSM, these plans also usually come with Part D benefits and provide coverage for many things Original Medicare doesn’t.
Medicare Supplement Insurance
If you choose to buy this insurance, you can do so during your one-time, six-month Medicare Supplement Open Enrollment Period, which starts when you enroll in Medicare Part B at age 65 or older. This is the only time companies must sell you a policy despite your health history or condition. If you wait until after your open enrollment period, or your policy lapses, you might not be able to buy another policy if you have a preexisting condition.
What about your spouse?
If your spouse is covered by your employer’s plan, you’ll have to consider what choices your spouse would have if you switched to Medicare. These may include COBRA or purchasing individual coverage like a Cigna Healthcare IFP plan in the private market or through a government exchange at www.healthcare.gov.
If you have coverage through your spouse’s employer—
Your situation depends on the size of your spouse’s employer:
20+ Employees
As long as your spouse continues working, you’ll be covered through their employer’s plan until you decide to enroll in Medicare.
<20 Employees
To ensure you have sufficient health coverage, you should enroll in both Parts A and B when you turn 65. In this case, Medicare pays before the employer’s insurance, which becomes secondary.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
Medicare Advantage vs. Medicare Supplement
Medicare Advantage vs. Medicare Supplement
Medicare Advantage and Medicare Supplement insurance policies provide different types of Medicare coverage. What are the similarities and differences, and which is better for you?
What’s the difference between Medicare Advantage and Medicare Supplement?
Medicare Advantage combines Medicare Part A and B for comprehensive coverage, all in one plan. It often includes Part D Prescription Drug coverage, too. These are also called Part C plans.
Medicare Supplement, also called Medigap, insurance policies help pay the out-of-pocket expenses not covered by Original Medicare (Part A and B). It is not part of the government’s Medicare program, but provides coverage in addition to it.
Here are the main differences between Medicare Supplement and Medicare Advantage:
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Plan Features
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Medicare Advantage (Part C)
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Medicare Supplement
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|---|---|---|
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Medicare Part A Hospital Coverage
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Yes
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No, but provides out-of-pocket expense coverage in addition to it1.
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Medicare Part B Medical Coverage
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Yes
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No, but provides out-of-pocket expense coverage in addition to it1.
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Medicare Part D Prescription Drug Coverage
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Usually included
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No, but you can buy separate coverage.
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Out-of-pocket expenses covered (deductibles, copays, coinsurance)
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No
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Yes—how much coverage you have depends on the policy you choose.
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Other coverage included (vision, dental, hearing)
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Yes—most plans include additional coverage.
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No, but you can buy separate coverage.
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Provider network
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Yes—your costs are lower when you visit in-network doctors and hospitals. (Some plans may allow you to see doctors and hospitals outside the network, for a higher cost).
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No—you can choose any doctor or hospital you’d like that accepts Medicare.
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Free programs and services
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Often includes no additional cost programs and services not covered by Original Medicare.
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Often includes no additional cost programs and services.2
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Offered through
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Private insurers like Cigna HealthcareSM
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Private insurers like Cigna Healthcare3
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Works with
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Part D Prescription Drug coverage, if not included
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Original Medicare and Part D Prescription Drug coverage
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Explore Cigna Healthcare Medicare Supplement Insurance or learn more about Cigna Healthcare Medicare Advantage plans.
Need Medicare coverage?
Cigna Healthcare has Medicare Advantage, Medicare Supplement, and Medicare Prescription Drug Plans.
Is it better to have Medicare Advantage or Medicare Supplement (Medigap)?
Whether you choose to apply for a Medicare Advantage plan vs. a Medicare Supplement insurance plan depends on your needs. Here are a few factors to consider when deciding whether Medicare Advantage or Medicare Supplement is better for you:
- Do you prefer to have all your coverage rolled into one plan? If so, a Medicare Advantage Plan may be the way to go. Many include Part D drug coverage, as well as vision, dental, and hearing, depending on the plan.
- Do you want financial protection from unexpected out-of-pocket costs, such as deductibles, copays, and coinsurance? If yes, Medicare Supplement plans work with Original Medicare and can help cover some of the remaining out-of-pocket expenses that Original Medicare doesn’t cover.
- Do you need a plan that provides coverage for disabilities or long term care facilities? If so, Medicare Advantage offers Special Needs Plans that provide this type of coverage.
- Do you want the freedom to see any doctors you choose? If so, Medicare Supplement plans have no required network and you can see any doctor that accepts Medicare, even if you’re away from home or traveling. Some Medicare Advantage plans may also allow you to see doctors and hospitals that are not in the plan’s network, giving you additional freedom to choose your doctors.
Learn more about Choosing a Medicare Plan
Can you have a Medicare Advantage plan and a Medicare Supplement plan?
Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.
Learn more about Medicare Supplement
Can you change from a Medicare Advantage plan to a Medicare Supplement plan?
During the Annual Enrollment Period, which runs from October 15 to December 7 each year, you are free to reconsider your Medicare coverage. If you decide you want to try a Medicare Supplement plan vs. Medicare Advantage plan, you can make that change during this period.4
Considering Medicare Advantage vs. Medicare Supplement? One is not better than the other. They provide different types of coverage. Finding the right fit for you depends on what kind of Medicare coverage you’re seeking, as well as your health care needs. Review all details of plans when shopping and be open to considering alternatives when your needs change.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
View Medicare Supplement state disclosures, exclusions, and limitations
¹Original Medicare (Part A and B) coverage is required in order to purchase a Medicare Supplement plan.
²These programs are NOT insurance and do not provide reimbursement for financial losses. Some restrictions may apply. Programs and services may be added or discontinued at any time. Customers are required to pay the entire discounted charge for any discounted products or services available through these programs. The Healthy Rewards program is provided by Cigna Health and Life Insurance Company. Programs are provided through third party vendors who are solely responsible for their products and services. Program availability may vary by location, and are not available where prohibited by law.
³Insured by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Insurance Company, Cigna National Health Insurance Company or Loyal American Life Insurance Company. In Kansas, insured by Cigna Health and Life Insurance Company, Cigna National Health Insurance Company, and Loyal American Life Insurance Company. American Retirement Life Insurance Company is not available to residents of Kansas and Kentucky. In Illinois, Maryland, North Carolina, Ohio, and Utah, insured by Cigna National Health Insurance Company domiciled in Ohio. In Pennsylvania, insured by Cigna Insurance Company. In Idaho and New Mexico, insured by Cigna Health and Life Insurance Company.
4Medicare Supplement plans may be subject to medical underwriting, and coverage may be denied.
View Kansas disclosures, exclusions, and limitations
Notice for persons eligible for Medicare because of disability:
In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont, and Wisconsin.
Tennessee Medicare Supplement Policy Forms
Plan A: CHLIC-MS-AA-A-TN; Plan F: CHLIC-MS-AA-F-TN; Plan High Deductible F (HDF): CHLIC-MS-AA-HDF-TN; Plan G: CHLIC-MS-AA-G-TN; and Plan N: CHLIC-MS-AA-N-TN
What is Medicare Supplement Insurance (Medigap)?
What is Medicare Supplement Insurance (Medigap)?
Get to know the basics of Medicare Supplement Insurance policies, what they cover and don’t cover.
What does Medicare Supplement, or Medigap, mean?
Medicare Supplement Insurance, also known as Medigap, is private health insurance that adds on to Original Medicare (Part A and B). It helps pay about 20%¹ of the Medicare expenses that Original Medicare doesn’t cover.
Video: What is Medicare Supplement?
This short video helps explain what a Medicare Supplement policy covers, and when and how you can use your Cigna HealthcareSM plan. (Length: 00:01:22)
What does Medicare Supplement Insurance cover?
Medicare Supplement Insurance helps cover some costs not paid by Original Medicare Part A and B. These plans help pay copays, coinsurance, and deductibles for your Part A (hospital care) and Part B (medical care), as well as additional out-of-pocket costs for things like hospitalization, doctor’s services, home health care, lab costs, durable medical equipment, and more.
Medicare will pay its share of the Medicare-approved amount for covered health costs. Then, your Medicare Supplement Insurance plan will pay its share of the costs it covers.
There are a wide range of Medicare Supplement plans that differ in coverage and costs, from basic to extensive.
Compare Medicare Supplement plans
Looking for a Medicare Supplement policy?
Cigna Healthcare offers policies with competitive rates and up to 25% premium discounts*.
What does Medicare Supplement Insurance not cover?
Medicare Supplement policies do not include prescription drug coverage or dental coverage. But you can buy those plans separately. Cigna Healthcare2 offers both prescription and dental plans, many with low cost monthly premiums.
How does Medicare Supplement Insurance work with Medicare?
Medicare Supplement Insurance works with Original Medicare Parts A and B. If you choose to buy a standalone Part D Prescription Drug plan, Medicare Supplement works with that, too.
Medicare Supplement Insurance is different from Medicare Advantage. You can have either a Medicare Advantage Plan or a Medicare Supplement Plan, but not both at the same time.
Who is eligible for Medicare Supplement Insurance?
If you are age 65 or older and enrolled in Original Medicare Part B, you may be eligible to apply for Medicare Supplement Insurance. You can apply for a Medicare Supplement plan at any time throughout the calendar year, but during your 6-month open enrollment period, you can buy any policy offered in your state and you are guaranteed coverage even if you have pre-existing health conditions.
- If you are retiring at 65 and applying for Medicare Part B, your open enrollment period lasts for 6 months starting the first day your Part B coverage begins.
- If you are not retiring until later and still getting medical coverage under your employer’s insurance, then your open enrollment starts when you do retire and sign up for Part B coverage.
Medicare Supplement plans are also available to you if you’re younger than age 65 and eligible for Medicare due to disability.
Learn more about Medicare Supplement Enrollment and Eligibility
What are the types of Medicare Supplement plans?
There are a wide range of Medicare Supplement plans. The different types of plans are named alphabetically, Plan A through Plan N. (Note, that they are not the same as other parts of Medicare, which are also named alphabetically.)
Medicare Supplement plans range from those that offer basic coverage, to those offering a much higher level of coverage. Understanding your health care needs, as well as your financial situation, can help when choosing a Medicare Supplement plan.
Find the right plan for you
Explore your options so you can enroll in the Medicare plan
you deserve.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
View Medicare Supplement state disclosures, exclusions, and limitations
*State variations apply. Discount not available in HI, ID, MN, and VT. For residents of WA, the discount is referred to as Spousal Premium Discount, and only applies to spouses. Discount percentage varies by state.
¹After the Part B Deductible has been met.
²Insured by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Insurance Company, Cigna National Health Insurance Company or Loyal American Life Insurance Company. In Kansas, insured by Cigna Health and Life Insurance Company, Cigna National Health Insurance Company, and Loyal American Life Insurance Company. American Retirement Life Insurance Company is not available to residents of Kansas and Kentucky. In Illinois, Maryland, North Carolina, Ohio, and Utah, insured by Cigna National Health Insurance Company domiciled in Ohio. In Pennsylvania, insured by Cigna Insurance Company. In Idaho and New Mexico, insured by Cigna Health and Life Insurance Company.
View Kansas disclosures, exclusions, and limitations
Notice for persons eligible for Medicare because of disability:
In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont, and Wisconsin.
Tennessee Medicare Supplement Policy Forms
Plan A: CNHIC-MS-AA-A-TN; Plan F: CNHIC-MS-AA-F-TN; Plan G: CNHIC-MS-AA-G-TN; Plan N: CNHIC-MS-AA-N-TN.
What is Medicare Part D?
What is Medicare Part D Prescription Drug Coverage?
Find out how Medicare Part D works, what it costs, and more.
What is Medicare Part D?
Medicare Part D Prescription Drug plans are part of the government’s Medicare program, but they are offered and managed through approved private insurers, like Cigna HealthcareSM. These plans help lower the cost of prescription drugs that can prevent complications from disease and help keep you healthy.
If you are entitled to Original Medicare Part A and/or enrolled in Medicare Part B, there are 2 ways you can get Part D Prescription Drug coverage.
- Enroll in a separate, or standalone, Medicare Part D Prescription Drug plan (when you turn 65 or during Open Enrollment).
- Choose to join a Medicare Advantage plan (Part C) that includes drug coverage. Not all Medicare Advantage plans include drug coverage.
- Review the details of any plan before you enroll.
Part D: Prescription Drug Coverage
- Helps lower prescription drug costs
- All Part D plans must offer at least a standard level of coverage set by Medicare
- Some Medicare Advantage Plans come with built-in prescription drug coverage
Part D plans are part of the government’s Medicare program, but they’re offered and managed through approved private insurers, like Cigna Healthcare. Enrollment in a separate Part D plan is not automatic. You need to select and enroll in a plan.
Looking for a Medicare Part D plan?
Our Part D plans come with low copays, large pharmacy network, and extensive drug list.
What are the pros and cons of Part D Prescription Drug plans?
Advantages of Medicare Part D Prescription Drug plans include:
-
Cost protection: Part D plans help protect against high-cost prescription drugs by offering various levels of cost coverage for different “tiers” of drugs.
-
Low premiums help make these plans affordable.
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Flexible plan options: Part D plans offer you choices in cost and benefit levels depending on your needs and other coverage you may have.
-
Works with Medicare Part A and Part B (Original Medicare), or may be included in a Medicare Advantage plan (Part C).
Disadvantages of Medicare Part D Prescription Drug plans include:
- Need to anticipate your prescription drug needs for the year: Part D plans differ in the types of drugs they cover. Knowing your medical situation can help you select a plan that is right for you and covers the prescription drugs you expect to need.
- Plans differ from insurer to insurer: Part D plans must offer a minimum amount of coverage per Medicare, but otherwise plans can differ. This means you need to shop around and educate yourself on what each plan covers.
- Not all drugs are covered: Each plan has its own drug list (formulary), level of cost coverage, and monthly premium.
- Late Enrollment Penalty (LEP): Fail to enroll in a Part D plan when you are eligible and you may end up paying a late enrollment penalty. For every month you delay enrolling, Medicare will charge you a small fee, which is added to your monthly premium.
Learn more about Medicare Part D Enrollment and the LEP
How do Medicare Part D plans work?
A typical Part D plan has 3 phases and works like this:
-
Deductible and Initial Coverage: The “typical” plan has an annual deductible. After you have paid costs equal to the deductible amount, then you have Initial Coverage. In this phase, you will only pay a copay or coinsurance on covered prescription drugs until you reach the Initial Coverage Limit, which starts the Coverage Gap.
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Coverage Gap: Also known as the “Medicare donut hole.” Here you pay a discounted amount for brand and generic drugs. Once your combined drug costs reach the upper level of the Coverage Gap, you move to Catastrophic Coverage.
-
Catastrophic Coverage: Starting in 2024, the plan pays the cost for covered prescription drugs for the remainder of the year.
Are all Part D plans the same?
Medicare requires Part D plans to provide a minimum standard level of coverage, but beyond that plans can differ in level of coverage, drug lists, and monthly premiums.
What drugs are covered by Medicare Part D?
Part D plans help pay for medications you take regularly to manage chronic conditions, for example, heart disease, high cholesterol, or asthma. It also pays for medications you take for a short period of time, such as antibiotics. There are also some medications covered by your Original Medicare Part B (Medical) plan and not covered by Part D.
Read more about Part B vs. Part D
What costs are involved in a Part D Prescription Drug plan?
Costs you pay out-of-pocket for a Part D prescription drug plan include the following:
- Part D monthly premium: This is a flat fee you may have to pay to your plan for providing you with coverage.¹
- Part B premium: You must continue to pay Part B premiums as part of your Original Medicare coverage.
- Copays and coinsurance: You and Medicare share a percentage of the costs for your prescription drugs. This means you pay part of your pharmacy drug costs (copays and coinsurance) and Medicare (through your plan) also pays part of your pharmacy drug costs.
If you choose a Medicare Advantage Plan that includes drug coverage, your monthly plan premium will include the medical and drug portion of the plan.
Note: In some cases, your premium may be higher if you didn’t sign up for Part D when you first became eligible.
There are no cost breaks for married couples. Medicare requires each spouse to pay separate premiums, deductibles, copays, and coinsurance for prescription drug coverage. Each spouse will reach each level of coverage according to their own drug costs over each calendar year.
Find out how much your Cigna Healthcare Part D premium will be based on your location
How to Pay Your Part D Premium
There are 4 ways to pay your Medicare Part D Prescription Drug Plan premiums:
- You can have your premium automatically deducted from your savings or checking account, or charged to a credit or debit card.
- You can have the premium deducted from your Social Security benefit/check (if your monthly payment covers your premium).
- The insurer you choose for your plan(s) can send you a bill each month.
- Your employer (or prior employer) might pay your Medicare benefits, so you pay little to no premium.
- Cigna Healthcare also offers the ability to pay your premiums online or over the phone.
Find out how you can pay your Cigna Healthcare Part D premium
Is there financial help for Part D?
Medicare provides assistance, known as Extra Help, in paying for prescription drug costs for those with limited income and resources.
If you qualify, you will receive help paying for any Medicare drug plan’s monthly premium, annual deductible (if applicable), and prescription copays or coinsurance. This Extra Help will count towards your out-of-pocket expenses.
How do you choose a Medicare Part D plan?
The following factors may affect how you choose a Part D plan:
- Consider the medications you take—how many medications do you take, are they available as generics, do you have a chronic condition that requires specialty medications like insulin, nebulizers, etc.?
- If you want prescription drug coverage as part of a Medicare Advantage Plan, make sure you review the details of that drug coverage—is it enough to cover your prescription needs?
- Standalone plans can differ among private insurers and offer various levels of drug coverage and different pharmacy networks.
- Review Part D plan options, considering monthly premium and other costs.
Related articles
What is Medicare?
Learn the basics of Medicare, including its purpose, how much it costs, what it covers and more.
Types of Medicare Plans
Explore the many different Medicare plan options so you can be ready to enroll in the plan that's right for you.
Choosing a Medicare Plan
No matter your needs or budget, Cigna Healthcare offers a wide range of plan options to choose from.
¹Most people will pay the standard monthly Medicare Prescription Drug Plan (Part D) premium. However, you may have to pay an extra amount because of your annual income. For 2023, single or married individuals filing separately whose income is $97,000 or above, and couples with an income of $183,000, will pay the extra amount.
If you are impacted, the Social Security Administration (not your Medicare Part D plan) will send you a letter telling you what the amount will be and how to pay it. This extra amount must be paid separately and cannot be paid with your monthly Part D premium.
What is Medicare Advantage (Part C)?
What is Medicare Advantage (Part C)?
Medicare Part C plans offer the benefits of Original Medicare in combination with prescription drug coverage and extra programs. Learn more about Part C coverage.
What do Medicare Advantage (Part C) plans cover?
Medicare Advantage plans (Part C) provide all of your Part A (hospital) and Part B (medical) coverage and must cover all medically necessary services. Many plans also offer prescription drug coverage and additional programs not covered by Original Medicare. To enroll in a Medicare Advantage Plan, you must already have Original Medicare Part A and B coverage.
Part C: Medicare Advantage Plan
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These plans are part of the government’s Medicare program, but are offered and managed through private insurers, like Cigna Healthcare. Medicare Advantage Plans may include plan extras not found in Original Medicare. You must be enrolled in Medicare Part A and Part B to join. |
Do Medicare Advantage Plans replace Medicare?
Medicare Advantage plans do not replace Medicare and are not a Medicare Supplement plan, either. Part C plans provide an alternative to Original Medicare (Part A [hospital] and Part B [medical]) and can offer additional coverage, including prescription drug coverage and extra programs and services.
Looking for a Medicare Advantage plan?
Cigna Healthcare offers plans with low or no monthly premiums, and often with dental and vision, too.
What are the pros and cons of a Part C Medicare Advantage plan?
Pros of Medicare Advantage Plans
With Medicare Advantage plans, you can get personalized, coordinated medical care at a lower cost, depending on your plan. There are many advantages of enrolling in a Medicare Advantage plan. You can get:
- All of your coverage bundled together in 1 convenient plan.
- Costs that may be lower than Original Medicare.
- Extra benefits such as coverage for vision, hearing, dental, wellness programs, and discounts on health-related items.
- Prescription drug coverage (if it’s included as part of the plan).
- All the rights and protections offered through the Medicare program.
- Help paying for premiums (subsidies), if you qualify.
- All the benefits of Medicare Part A and Part B plans, without buying supplemental insurance.
Cons of Medicare Advantage Plans
The following are some disadvantages of Medicare Advantage plans:
- If you select an HMO Medicare Advantage plan, you may have a small selection of providers to choose from. If you see a provider out-of-network, it can cost you more. However, other plan options will offer a wider provider network.
- With certain plans, you may see additional costs for things like drug deductibles and specialist visit copays.
- If you travel a lot, your plan may not cover services outside your service area.
What types of Medicare Advantage plans are available?
There are various kinds of Medicare Advantage plans, such as HMO, PPO, and Private Fee-for-Service plans. HMOs and PPOs each have certain characteristics, whether they are part of a Medicare plan or part of a regular health plan.
For example, an HMO plan typically comes with lower costs but requires you to see providers within a network and get referrals before you see a specialist. A PPO plan typically costs more, but offers more flexible options for seeing providers and may not require any referrals to see specialists.
Confused by Medicare terms?
What does a Medicare Advantage plan cost?
Depending on your Medicare Advantage plan, the costs you pay out-of-pocket can vary:
- You may pay a deductible, a certain amount you must meet before your plan begins to pay.
- There may be copays for doctor visits—this is a flat fee usually due at the time of the visit.
- You may have to pay a share for lab services and medical equipment.
- You will pay a monthly plan premium if there is one.
- You will continue to pay the Original Medicare Part B monthly premium, as well.
- Additional coinsurance or copays if you see providers outside your plan network.
To help control your costs, make sure you understand the terms of your plan and the out-of-pocket costs you may be required to pay.
How do I choose a Medicare Advantage plan?
It’s important to compare the benefits between your current coverage and the different types of Medicare Advantage plans (Part C). Be sure that you understand the additional benefits and any benefits (or freedoms) that you may lose.
You may want to consider:
- If you can change your current doctors
- If your medications are covered under the plan’s formulary (if prescription drug coverage is provided)
- The monthly premium
- The cost of coverage. This could include annual deductible, copays, and coinsurance.
- What additional services are offered (i.e. preventive care, vision, dental, health club membership)
- Any treatments you need that aren’t covered by the plan
How do I enroll in a Medicare Advantage plan?
If you want to enroll in a Medicare Advantage plan, you must:
- Be eligible for Medicare
- Be enrolled in both Medicare Part A and Medicare Part B (you can check this by referring to your red, white, and blue Medicare card)
- Live within the plan’s service area (which is based on the county you live in–not your state of residence)
- Not have end-stage renal disease (ESRD)
Want more information about enrollment? Visit Medicare Part C Eligibility and Enrollment Information
Can I change my Medicare Advantage plan?
There are a few times during the year that you may be eligible to change your Medicare Advantage (MA) plan:
Annual Enrollment Periods
The Medicare Annual Enrollment Period (AEP) occurs every year from October 15-December 7. Anyone who is eligible for Medicare can change plans during this time. You can make as many changes to your plan as you’d like before December 7, and your new coverage begins January 1.
Medicare Advantage Open Enrollment occurs every year from January 1-March 31. This period is for Medicare Advantage customers only and is your opportunity to:
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- Switch to another Medicare Advantage plan that better fits your needs, with or without drug coverage
- Switch to Original Medicare Part A and Part B, and add a standalone Part D prescription drug plan if you’d like one.
Learn more about Original Medicare
You can only make one change to your Medicare Advantage plan during this period. Your new coverage will begin the first of the month after you make the switch.
Special Enrollment Periods
If you need to change your MA plan outside of the standard enrollment periods described above, you may be eligible for a Special Enrollment Period (SEP) for these qualifying events:
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- Moving outside your plan’s coverage area
- New Medicare or Part D plans are available due to a move to a new permanent location
- Recently released from prison
- Your plan is not renewing its contract with the Centers for Medicare & Medicaid Services (CMS) or will stop offering benefits in your area at the end of the year
CMS may also establish SEPs for certain “exceptional conditions” such as:
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- If you make an MA enrollment request into or out of an employer-sponsored MA plan
- If you want to disenroll from an MA plan in order to enroll in the Program of All-inclusive Care for the Elderly (PACE).
- If you dropped a Medicare Supplement (Medigap) insurance plan when you enrolled for the first time in an MA plan and you’re still in the federally mandated “trial period” 12 months after the purchase of your MA plan
- If you enrolled in a Special Needs Plan (SNP) but are no longer eligible
- If you were a non-U.S. citizen and have become “lawfully present” as a “qualified non-citizen” without a waiting period in the United States
To confirm if you’re eligible for a SEP, contact us.
What is Original Medicare (Part A and Part B)?
What is Original Medicare (Part A and Part B)?
Original Medicare has 2 parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Learn more about the benefits and costs of Original Medicare.
How does Original Medicare work?
Original Medicare is a federal health care program made up of both Medicare Part A (hospital insurance) and Part B (medical insurance). It’s a fee-for-service plan, which means you can go to any doctor, hospital, or other facility that’s enrolled in and accepts Medicare, and is taking new patients.
Medicare was set up to help people 65 and older. In 1972, Medicare became available to people with disabilities and End-Stage Renal Disease/kidney failure.
What does Medicare Part A and Part B cover?
Original Medicare
Part A
Hospital Insurance
- Hospital Stays
- Skilled nursing facilities
- Hospice care
- Some Home Health Care
You can enroll in Medicare Part A once you turn 65. If you’re already collecting Social Security disability benefits, you’ll be automatically enrolled in Part A.
Part B
Medical Insurance
- Doctor visits
- Outpatient care
- Medical supplies
- Some preventive services
Medicare pays 80 percent of approved charges and you pay about 20 percent.
Part B is optional because you have to pay a monthly premium and meet a deductible before Medicare will pay benefits.
Looking for a Medicare Advantage plan?
Cigna Healthcare offers plans with low or no monthly premiums, and often with dental and vision, too.
What does Medicare Part A
and B not cover?
Medicare Part A and Part B does not cover:
- Long-term care (i.e. nursing homes)
- Most dental care (i.e. dentures)
- Eye exams for prescription glasses
- Cosmetic surgery
- Hearing exams and hearing aids
- Routine foot care
- Health care outside of the US
Confused by Medicare terms?
What’s the difference between Medicare Part A and Medicare Part B?
Part A is the hospital services part of Medicare. This benefit covers inpatient care, hospital stays, skilled nursing facility care, hospice care, and medically needed home health care services.
Part B is the medical services part of Medicare. It covers many of the medically necessary services not covered in Part A, such as outpatient and preventive services. This involves things like X-rays, bloodwork, doctor’s visits, and outpatient care. It will also cover other medical items such as diabetic test strips, nebulizers, and wheelchairs.
Do Medicare Part A and Part B cover prescription drugs?
Original Medicare (Part A and Part B) only covers prescriptions in a couple of instances. This can be medications you get as part of inpatient hospital care, as well as injections and infusions you may get in a doctor’s office.
Find out more about Part B vs. Part D drug coverage
You’ll need to enroll in a Medicare Part D Prescription Drug Plan to be covered for outpatient prescription medications.
Learn more about Medicare Part D Prescription Drug Plans
What do Medicare Part A and B cost?
With both Medicare Part A and B, you have to pay annual deductibles, coinsurance, and copays. For certain medical procedures, you may have additional out-of-pocket costs to pay. You can buy a Medicare Supplement Insurance plan (Medigap), which can help pay some of these costs.
What does Part A cost?
With Medicare Part A, you may have to pay copays and deductibles for hospital stays, but may not have to pay a monthly premium. Copays and deductibles apply to hospital benefit periods, which start when you enter a hospital or skilled nursing facility, and end 60 days after you’ve left the facility (as long as you have not received skilled care in any other facility during those 60 days). It’s important to note that:
- For each hospital benefit period, you pay a deductible.
- You pay a copay if you’ve stayed in a hospital for more than 60 days.
- There’s no deductible or copayment for home health care or hospice care.
For many people, Part A comes without a monthly premium. You may have no monthly premium if you paid a certain amount toward Medicare taxes while working. In this case, you are often automatically enrolled in premium-free Part A.
If you don’t automatically get premium-free Part A, you may be able to buy it if you (or your spouse/partner):
- Are age 65 or older and allowed to (or are enrolling in) Part B to meet the citizenship and residency requirements.
- Are under age 65 and are disabled but no longer get premium-free Part A because you returned to work.
What does Part B cost?
With Medicare Part B, you pay a standard monthly premium that’s based on your income. In some cases, your monthly premium may be higher if you didn’t sign up for Part B when you became eligible.
You may also need to meet an annual deductible before Medicare kicks in and starts paying. Once you’ve met your deductible, you will pay a 20 percent copay for approved Medicare Part B services.
You can always buy a Medicare Supplement Plan that pays your Part B deductible, as well as other out-of-pocket costs such as copays and coinsurance.
How do you enroll in Original Medicare (Part A and Part B)?
To enroll in Original Medicare (Part A and Part B), you must be 65 and don’t necessarily have to be retired. Initial enrollment period packages are sent to people 3 months before they turn 65 or during their 25th month of disability benefits.
If you’ve received Social Security disability benefits for 24 months, you are automatically enrolled in Part A and Part B.
Need help paying for Medicare?
Medicare gives financial aid for people who have limited income and support. If you feel you may qualify, you can learn about eligibility requirements by either:
• Visiting www.socialsecurity.gov
• Or calling the Social Security Administration at 1 (800) 772-1213. (TTY/TDD users should call 1 (800) 325-0778).
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