What is Medicare?

Let’s look at Medicare Basics.  Medicare is a federal program that ensures citizens who are 65 and older or disabled have affordable health care options. It is a complex system of insurance to understand because of the rules, regulations, deadlines, penalties, compliance guidelines and procedures set forth by the federal government.  Take a look at the Medicare Basics below.

Our experienced and knowledgeable team is well versed on the ins and outs of Medicare. We would be glad to assist you along your Medicare purchasing journey to ensure that you find the best coverage options for your individual needs and that you are properly educated on your Medicare coverage.

What are the different parts of Medicare?

There are four parts of Medicare (plus Medicare Supplements) briefly explained below:

   Part A – Original Medicare

 This is your hospital insurance plan.  Medicare Part A covers nursing care and hospital stays, but does not cover doctors’ fees.  Medicare Part A also covers some home health services like skilled nursing care after a hospital stay as well as hospice care.  If you have been employed most of your life and paid payroll taxes you will not likely have to pay a monthly premium for Medicare Part A.  Instead this will be automatically deducted from your social security check.

   Part B – Your Medical Coverage

 Medicare Part B is optional.  You may choose to opt out of Medicare Part B if you continue to carry health insurance through an employer, union, your spouse, etc. Medicare Part B pays for a portion of your doctor visits, some home health care, medical equipment, outpatient procedures, rehabilitation therapy, laboratory tests, X-rays, mental health services, ambulance services, and blood. You are required to pay a monthly premium to Medicare for Medicare Part B coverage.

Part C – Medicare Advantage Plans (Click to learn More)

 Medicare Part C plans are offered through private insurance carriers but are approved by Medicare.  In order to enroll in Medicare Part C you must be enrolled in both Medicare Part A and Part B.  Medicare Part C plans pay for the same health services as original Medicare but they often pay for services that ARE NOT covered by original Medicare.  For example:  vision and dental care.  Many of these plans also provide prescription drug coverage. Medicare Advantage plans are generally organized as health maintenance organizations (HMOs) or preferred provider organizations (PPOs).

   To learn more about HMOs and PPOs click on the video to the right.

   Part D – Prescription Drug Coverage (Click to learn more)

 Medicare Part D is a stand-alone plan that provides prescription drug coverage.  Medicare Part D is not mandatory and may be purchased to work alongside your original Medicare.   Generally you will pay a premium for Medicare Part D along with co-payments and coinsurance which varies among plans.  It is important to ensure that your plan covers your medications.  Every plan has a formulary of covered drugs which can change and varies between plans.  Medicare Part D also offers catastrophic coverage for very high drug costs after a certain amount of out-of-pocket expenses are met. 

   Medicare Supplement Plans (Click to learn more)

 Medicare Supplements (Medigap Plans) are supplemental insurance plans offered through private carriers that help to cover some of the costs of original Medicare.  Medigap plans generally help cover gaps in co-payments, coinsurance and yearly deductibles that original Medicare does not provide. These plans can also help pay for some services that are not covered through Medicare like emergency overseas travel and Part B excess charges.  You must be enrolled in Medicare Part A and Medicare Part B in order to be eligible for a Medicare Supplement policy.  Medicare Supplements are not intended to provide stand-alone coverage. 

Medicare Supplement policies DO NOT include Medicare Part D and CANNOT be used with Medicare Advantage Plans.  Also, they only cover one person so spouses must have their own plan.  You are expected to pay a monthly premium (Some plans offer a $0 premium option) on your Medicare Supplement policy in addition to the Medicare Part B premium and your policy is guaranteed renewable as long as you continue to pay your premium. 

Need assistance with Medicare Basics?  Contact us today we would be glad to help you navigate the Medicare landscape.