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Medicare 101:
Medicare Basics
Part A
Hospital
Part A covers inpatient hospital care. While you are in the hospital it covers everything that is crucial for your treatment. Like your medications, X-rays, lab tests, operations, and meals. It can also pay for necessary follow-ups to inpatient care like physical therapy or skilled home nursing care. And, it covers hospice services for the terminally ill.
The federal government provides Part A, and most people don't pay a monthly premium. If you're admitted to a hospital, there's a deductible and some further cost sharing that you
Part B
Medical
Part B covers doctor's care when you're sick or have a medical condition. It pays for outpatient hospital and clinical care, lab tests, and some nursing care at home if you're homebound.
Part B generally makes it easier to get preventative care, including things like your annual wellness exam, preventative screenings, and yearly flu shots. It can cover the medical equipment you need for your home. And it can cover you if you have to go to the emergency room. It also covers most doctor services while you're in the hospital.
The federal government provides Part B, and you'll have to pay a monthly premium. For visits to the doctor, part B has a deductible and some cost sharing that you pay.
There isn’t a one-size-fits-all Medicare Plan
Helping you find the plan that works for you is what we do.
We accomplish our mission by providing you with the options available in your area and the guidance of a trusted, independent agent who understands the plans and your needs.
Medicare is complex, and there’s a lot of useful—and some not so useful—information out there. To simplify the complicated world of Medicare, we’ve broken it down into its main parts, & the coverage available.
Original Medicare
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Your options beyond Parts A and B
Part C
Medicare Advantage
An all-in-one option you can purchase to replace Part A and B.
Medicare Advantage combines the coverage of Part A and B (Original Medicare), plus extra benefits. Many plans include prescription drug coverage as well as dental and vision care. Some plans have no copays for most labs or tests. Some even have extra benefits like gym memberships and transportation.
Most plans offer $0 premium network-based HMO plans. You still have to pay your Part B premium. Most plans have copays for treatment. Medicare Advantage plans have a yearly limit for out-of-pocket costs you have to pay. Different plans have different maximums.
Medicare Advantage plans work all by themselves. They replace Medicare Parts A and B and because of this all-in-one approach, you don't pair them with Medicare Supplement policies.
Part D
Prescription Drug Plan
Part D covers your prescription drugs and is a great addition to pair with Medicare supplement insurance. You probably won’t need it if you get Medicare Advantage since most Medicare Advantage plans include it. Remember what prescriptions are covered depends on which plan you get. But you most likely won’t need it if you choose Medicare Advantage instead. You can also pair it with Medicare supplement insurance for even more coverage. Just remember: which prescriptions are covered depends on which plan you get.
You have to get your Prescription Drug Plan through a private insurer, like Mutual of Omaha. You’ll pay a monthly premium and a yearly deductible. You'll also pay a coinsurance (a percentage of the cost for your prescriptions) or a copay (a flat fee for some of your prescriptions’ cost).
Medigap
Medicare Supplement
Medicare Supplement (also known as Medigap) covers things that Original Medicare doesn’t, like copays, deductibles, and coinsurance. It does all this with a steady, predictable, monthly bill you can budget for. And it can’t be canceled. It will be renewed for as long as you pay your premium on time. Medicare Supplements work in coordination with Original Medicare (A+B), therefore, they have no defined networks. You are permitted to see any doctor that accepts Medicare.
You can add a Prescription Drug Plan and a Dental plan to Medicare supplement insurance to get even more coverage.
You have to get Medicare supplement insurance through a private insurer. You’ll have to pay a monthly premium and depending on the plan you may also have copays.
Two Different Options for Comprehensive
Medicare Coverage
Medicare Supplement Insurance
Medicare provides a lot of coverage, but it doesn’t cover everything. If you need supplemental coverage, then Medicare Supplement insurance may be for you. Medicare Supplement policies supplement Original Medicare. They can help you pay for some of the health-care costs associated with Original Medicare, including co-payments, coinsurance, and deductibles. Some policies also cover services that Original Medicare doesn’t, like medical care outside of the U.S. Medicare Supplement policies are sold by private insurance companies and have a monthly premium. In order to qualify for them, you must have Medicare Part A and Part B.
Medicare Supplement Insurance coverage can help you:
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Better manage your health care expenses
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Pay out-of-pocket costs for Medicare-approved services
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Stay within your household budget
Preparing for unexpected medical expenses can provide great comfort, knowing that you won’t put your savings at risk. And with Medicare Supplement Insurance, you won’t have to deal with health networks that restrict your health care options. You can choose the doctors and health care providers of your choice, including specialists and health facilities, as long as they accept Medicare.
Get the facts you need from a company you can trust.
Before you purchase any Medicare Supplement Insurance policy, make sure you have plenty of information about what the coverage includes, so you can choose the plan that best fits your specific needs.
Medicare Advantage Plans
Medicare Advantage plans (MA), are offered through private insurance companies and approved by Medicare. Before enrolling in a Medicare Advantage plan, you must first enroll in Original Medicare — both Part A and Part B.
By law, Part C plans must pay for at least the same health care services as Original Medicare. But they sometimes pay for things that are not covered by Original Medicare, such as vision and dental care. Most, but not all, Medicare Advantage plans also provide some prescription drug coverage.
Additional Information
How do I apply for Medicare?
For Medicare Part A and Part B, some people get them automatically while others have to sign up. Whether you have Social Security and how long you've worked and paid into Medicare play a big role in how and if you need to apply. If you are someone who is automatically enrolled, you'll receive your Medicare Card in the mail 3 months before your 65th birthday.
Don't know which bucket you fall into? Contact us for more information about what to expect and plan for.
When can I apply for Medicare?
You can enroll in Medicare starting three months prior to the month of your 65th birthday and extending for three months after the month of your birthday. (If your birthday is on the first of the month, you can enroll beginning four months prior to the month of your 65th birthday but only two months after the month of your birthday).
You apply at your local Social Security Office, either online, by phone, or in-person.
How do I switch plans or add more coverage to my Medicare solution?
You can apply for a new Medicare supplement insurance plan at any time. However, you could be denied due to health conditions. If you want to switch between a Medicare Supplement plan and a Medicare Advantage plan, you need to switch during certain periods of time and depends on your current health conditions. For Medicare Advantage and Prescription Drug Plans you can apply during the Annual Enrollment Period from October 15 to December 7 of each year. You cannot be denied this coverage, and it will be effective the following January 1.