WHAT IS MEDICARE?

PARTS OF MEDICARE

One enrolls in Original Medicare (Part A and Part B) through the Social Security Administration.

Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care. Medicare Part A does not have a maximum out of pocket limit.

Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services. Medicare Part B does not have a maximum out of pocket limit.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

 

Supplemental (Medigap) policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.

 

Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B. Medicare Advantage plans can also provide coverage for prescription drugs and additional benefits such as vision, hearing, and dental all in one bundled together plan.

 

Medicare Part D (Stand Alone Medicare prescription drug coverage) helps cover the cost of prescription drugs.

PART A

Most people aged 65 or older are eligible for free Medical hospital insurance (Part A) if they have worked and paid Medicare taxes long enough. If you haven’t worked enough years to get Part A you could pay up to $471 per month in 2021. Although the Medicare cars says “Hospital Part A” this is only for an admission and a few other benefits. If you went to the hospital as an outpatient or even the emergency room and Observation as these expenses could be Part B expenses. Medicare makes an example chart of different scenarios.

SIGNING UP FOR PART B

Social Security Does not necessarily automatically sign you up for Medicare Part B. Most need to take active steps to go to Social Security and sign up. Because you must pay a premium for Part B coverage, you can turn it down in the event you are auto-enrolled.

You can enroll in Medicare medical insurance (Part B) by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read Medicare Premiums:  Rules for Higher-Income Beneficiaries.

If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a "Special Enrollment Period" (SEP). Actively working and receiving full major medical coverage is generally considered creditable coverage and would afford you and your spouse a special enrollment period when you decide to quit working.

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Before starting Medicare get a copy of Social Security’s Medicare publication for more information.

MEDICARE ADVANTAGE

WHAT ARE MEDICARE ADVANTAGE PLANS?

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” are offered by Medicare-approved private companies that must follow rules set by Medicare.

 

Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans like Health Maintenance Organizations (HMOs), Preferred Provider organizations (PPOs) and Private Fee for Service (PFFS) plans. Each of these Medicare Advantage plan types have special rules about how you get your Medicare covered Part A and B services and your plan’s supplemental benefits.

 

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

 

You must use the card from your Medicare Advantage Plan to get your Medicare covered

services. Keep your red, white and blue Medicare card in a safe place. because you’ll need it if you ever switch back to Original Medicare.

MEDIGAP
also known as Medicare Supplement

WHAT IS MEDIGAP?

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies and does not have a maximum out of pocket limit. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments

  • Coinsurance

  • Deductibles

Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:

  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.

  • Then, your Medigap policy pays its share.

8 THINGS TO KNOW ABOUT MEDIGAP POLICIES: 

  1. You must have Medicare Part A and Part B.

  2. A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

  3. You pay the private insurance company a monthly Premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

  5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

  7. Medigap policies sold after 2006 do not include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D). If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.

  8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.

MEDICARE PART D

(Medicare prescription drug coverage)

Medicare drug coverage helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered. These are plans offered by private insurance companies that contract with Medicare.

 

 There are 2 ways to get Medicare drug coverage:

1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee‑for‑Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.

2. Medicare Advantage Plan (Part C) or other Medicare health plan with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

 

It is important to pick a Part D plan that meets your needs. Each carrier has it’s own drug formulary that can vary from plan to plan.