Medicare

Understand the Basics

The Parts of Medicare and How it Works

Medicare is a federal health insurance program for people 65 and older and others with disabilities. Medicare Part A and Medicare Part B are “Original Medicare”. Part A provides coverage for hospital care and Part B provides coverage for doctor visits and certain outpatient care. Original Medicare covers 80% of Medicare approved services and does not limit your out-of-pocket expenses. Since not all costs for approved health care services and supplies are covered with Part A & Part B, many people choose to enroll in a Medicare insurance plan to help pay for costs and benefits that aren’t paid for with only Original Medicare.

The Parts of Medicare

Original Medicare
Insurance Plan Options
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PART A

  • Inpatient Hospital Care
  • Skilled Nursing Services
  • Hospice Care
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PART B

  • Doctor's Visits
  • Outpatient Hospital Services
  • Durable Medical Equipment
  • Physician Administered Drugs
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PART C

  • Medicare Advantage Plans offered by private insurance companies
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PART D

  • Prescription Drug Coverage
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MEDIGAP

  • Supplemental insurance that helps fill "gaps" in Original Medicare (sold by private companies).
  • An alternative option to Part C
  • Can be paired with a standalone Part D prescription drug plan

"Hospital Insurance"

"Medical Insurance"

"Medicare Advantage"

"Prescription Drug Coverage"

"Medigap/Medicare Supplement"

Medicare Insurance Options

Medicare insurance options are offered by private companies approved by Medicare and include Medicare Advantage (also known as “Part C”), Prescription Drug Coverage (also known as “Part D”) and Medicare Supplement (also known as “Medigap”). Medicare Advantage and Medicare Supplement plans may include coverage for benefits that original Medicare does not cover like vision, hearing, dental or prescription drug coverage. With Medicare insurance plans, you can:

  • Enroll in a Medicare supplement plan. You must have both Part A & B to enroll in a Medicare Supplement plan. Medicare supplement plans are mostly standardized across the United States and there are eight plans for those who became eligible for Medicare after January 1, 2020. With Medicare Supplement plans, you can see any provider across the U.S. that accepts Medicare and services.

AND

  • Enroll in a stand-alone prescription drug plan if you don’t have other creditable drug coverage. You should enroll in a prescription drug plan when first eligible or during a Special Enrollment Period to avoid a penalty later.

OR

  • Enroll in a Medicare Advantage plan (Part C). Medicare Advantage plans bundle Part A & B and usually prescription drug coverage (Part D) into a single plan. You must have both Part A & B to enroll in a Medicare Advantage plan and plan availability is determined by where you live.

If you have other insurance and Medicare, one will pay “Primary” and the other will pay “Secondary” and benefits will be coordinated.  Depending on which non-Medicare insurance plan you have, that will determine if Medicare pays primary or secondary. The insurance that pays primary pays up to the limits of its coverage and the plan that pays secondary only pays if there are benefits available that the primary insurer didn’t cover.

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