LEARN MORE ABOUT MEDICARE & YOUR OPTIONS

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    • Home
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      • Summary of Options
      • Accident Insurance
      • Dental
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      • RBP Health Plan Solutions
      • Special Risk Insurance
    • Medicare
      • About Medicare
      • Medicare Basics
    • Contact Us
Spiro Benefits
  • Home
  • About Our Company
  • Our Services
  • Insurance Options
    • Summary of Options
    • Accident Insurance
    • Dental
    • Disability Insurance
    • Hospital Confinement
    • Life Insurance
    • RBP Health Plan Solutions
    • Special Risk Insurance
  • Medicare
    • About Medicare
    • Medicare Basics
  • Contact Us

MEDICARE BASIC BREAKDOWN

older couple with dog

MEDICARE IS MADE UP OF 4 PARTS -

PART A - ORIGINAL MEDICARE

 provides inpatient/hospital coverage.

PART B - ORIGINAL MEDICARE

provides outpatient/medical coverage.

PART C - MEDICARE ADVANTAGE

offers an alternate way to receive your Medicare benefits.

PART D - MEDIGAP

provides prescription drug coverage.


PART A & PART B - ORIGINAL MEDICARE

The federal government provides Part A and Part B,  Original Medicare. 


You must be enrolled in Original Medicare before you  can sign up for supplement coverage options like Medicare Supplement/Part D, or  Medicare Advantage.


Part A is hospital insurance. It will help cover:

  • Inpatient hospital care
  • Short-term skilled nursing facilities
  • Hospice care
  • Some home health care services


Part B is medical insurance. It will help cover:

  •  Doctor visits
  •  Ambulance services
  •  Durable medical equipment


What does it cost me?

Part A and Part B have monthly premiums, deductibles and coinsurance.


  Most people don't pay the Part A premium, thanks to the Medicare taxes  they paid while working. 


Everyone pays the Part B premium. This amount  changes yearly and varies based on income.  Keep. mind If you enroll late for Part B,  you could have a penalty fee added. Also, there is no limit on what you  pay out of pocket with Original Medicare.


What's not covered?

Original Medicare does help provides coverage for hospital and medical services, but it doesn't cover everything.


In general, Original Medicare pays for  80% of covered health care costs. It's up to you to pay the remaining 20%. 


Original Medicare doesn't  cover most prescription drugs or other benefits such as vision, dental,  hearing services, or long-term nursing and home health care. 

Depending on your health situation that can be big expense and that is where supplement insurance can help.

  Supplements,  PART C or D are smart choices to add on for coverage.  

SUPPLEMENT COVERAGE OPTIONS - MEDICARE SUPPLEMENT / PART D

Additional coverage

Many choose to buy  additional insurance to help cover the 20%. Some choose a Medicare  Supplement (Medigap) plan and/or a Part D prescription drug plan, while  others choose a Medicare Advantage plan..


Medicare Supplement (Medigap) and Part D prescription drug plans (PDP) work alongside Original Medicare. These  plans are made available through private health insurance companies,  though they are regulated by the government.

You must enroll in Parts A and B and either (or both) Medicare  Supplement and Part D for more comprehensive health care coverage.


Medicare Supplement plans help pay your share of health care costs, such as copays, coinsurance, and deductibles. They also have their own monthly premium.


Part D prescription drug plans (PDPs) are  stand-alone plans that help pay for medications you buy from a pharmacy  or through a mail-order pharmacy service.

PDPs have their own monthly premium, plus a yearly deductible, copays, and coinsurance.


Part D plans may feature these pharmacy types as part of their network:  Retail chain or big box store pharmacies, mail order, specialty  pharmacies, and long term care pharmacies. These plans may also feature preferred pharmacies, where you pay a lower co-payment for prescriptions—a real cost savings compared to paying for prescriptions elsewhere.


What does it cost me?

Health insurance  companies set the prices for these types of coverage. Costs can be  determined by things such as age, whether you use tobacco, and your  location.

MEDICARE ADVANTAGE PART C Original Medicare, Medicare Supplement / Part D aren't the only option available to you. There's one more we'll cover and that's Part C, also known as Medicare Advantage.

What is the Medicare Advantage?  


Health insurance companies provide Medicare Advantage plans that  are regulated by the government. These plans are sometimes referred to  as an "all-in-one" option. They combine Original Medicare services with  benefits such as vision, dental, hearing, or prescription drug coverage.

These plans don't replace Part A and Part B . You still need to enroll in Original Medicare before you enroll in a Medicare Advantage plan.


For many seniors, Medicare Advantage plans can work well.  A study in the Journal of the American Medical Association found that those enrolled in the Advantage option often receive more preventive care than those in traditional Medicare.  This provides an alternative option to traditional supplements to consider. 


Unlike Traditional  Medicare, for which an individual pays a separate monthly premium for  hospital visits, doctors/outpatient, and prescription drugs, Medicare  Advantage typically covers all in one monthly premium, often with extra  benefits at a lower cost to the enrollee.

To learn more about your options

There's much to see here and so much more in depth information to review. So, take your time, look around.  When you are ready please reach out and we will set up a consult for you to go over your specific needs and educate you on options.  With the full understanding of what is available you will be able to make the best decision that suits your healthcare needs.  We are here for you.

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