MEDICARE BASIC BREAKDOWN
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.
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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.