Understanding the Financial Basics of Retirement Healthcare
Before you can choose a plan, you need to understand the fundamental building blocks of health coverage for American seniors. The system is primarily built around Medicare, a federal health insurance program for people who are 65 or older. Let’s break down the key components.
The Parts of Original Medicare
Original Medicare is the traditional, government-run program. It is divided into two main parts:
Medicare Part A (Hospital Insurance): Think of Part A as your hospital coverage. It helps pay for inpatient care in a hospital, skilled nursing facility care following a hospital stay, hospice care, and home health care. For most people, Part A is premium-free because you or your spouse paid Medicare taxes while working for at least 10 years. However, it is not completely free; you will still be responsible for a deductible for each hospital stay and coinsurance for extended stays.
Medicare Part B (Medical Insurance): Think of Part B as your doctor and outpatient coverage. It helps pay for services from doctors and other healthcare providers, outpatient care, durable medical equipment (like walkers or oxygen tanks), and many preventive services. Part B has a standard monthly premium, which can be higher depending on your income. In 2024, the standard premium is $174.70, but if your modified adjusted gross income from two years prior was above $103,000 (for an individual) or $206,000 (for a married couple), you will pay a higher amount. This is called the Income-Related Monthly Adjustment Amount (IRMAA).
The Two Main Paths for Your Coverage
Once you are enrolled in Parts A and B, you face a critical choice. You must decide which path to take to round out your health coverage. You cannot have both at the same time.
Path 1: Original Medicare + Part D + Medigap
- Medicare Part D (Prescription Drug Coverage): Original Medicare does not cover most prescription drugs. Part D plans are sold by private insurance companies and help cover the cost of your medications. You choose a standalone Part D plan and pay a separate monthly premium for it.
- Medigap (Medicare Supplement Insurance): Original Medicare has “gaps” in its coverage, such as deductibles, copayments, and coinsurance, which can add up quickly. A Medigap policy, also sold by private companies, helps pay for some or all of these out-of-pocket costs. There are several standardized plans (e.g., Plan G, Plan N) to choose from.
With this path, you have three separate cards and potentially three premiums: one for Part B, one for Part D, and one for your Medigap policy. The major benefit is the freedom to see any doctor or visit any hospital in the U.S. that accepts Medicare, with no network restrictions or referral requirements.
Path 2: Medicare Advantage (Part C)
A Medicare Advantage plan is an all-in-one alternative to Original Medicare. These plans are offered by private insurance companies approved by Medicare. By law, they must provide all the same benefits as Medicare Parts A and B. However, most Medicare Advantage plans also bundle in other benefits, such as:
- Prescription drug coverage (known as an MA-PD plan)
- Dental, vision, and hearing coverage
- Gym memberships or wellness programs
These plans often have low or even $0 monthly premiums (you must still pay your Part B premium). They typically operate with a provider network, like an HMO or PPO, meaning you may need to use doctors and hospitals within that network to get the lowest costs. They also have an annual out-of-pocket maximum, which limits how much you will spend on medical costs in a year—a protection that Original Medicare does not have on its own.
