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Medicare
Medicare serves as health coverage for individuals aged 65 and above. Those with a disability, End-Stage Renal Disease (ESRD), or ALS (commonly known as Lou Gehrig’s disease) may qualify for Medicare before reaching the age of 65. While some individuals are automatically enrolled in Medicare, others must actively apply for it based on whether they begin receiving retirement or disability benefits from Social Security prior to turning 65.
Part A
Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care, hospice, and home health-care services. You may have to pay various deductibles, coinsurance, and copayments. You earn Part A by paying taxes toward Medicare while working for 10 years (or 40 quarters). If you did not earn Part A, you will pay a premium.
Part B
Medicare Part B covers services that treat illnesses or conditions such as doctor’s office visits, lab work, x-rays, and outpatient surgeries. It also covers preventive services like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Most people pay a premium for Part B. Even if you are enrolled in a Medicare Advantage plan that provides your Part A and Part B benefits, you will still pay your Part B premium.
Part D
Original Medicare does not include coverage for prescription medications. Opting for Medicare Part D can be beneficial if you require medication. Failure to enroll in Medicare Part D Coverage when first eligible will result in a penalty. You have the option to obtain Medicare Part D prescription drug coverage through either a standalone Prescription Drug Plan (PDP) or a Medicare Advantage Plan that incorporates prescription drug coverage.
Medicare Supplemental
Choices
Before making a decision on a plan, we want to ensure that you understand the distinctions between the various options available to you. Specifically, clarifying the differences between Medicare Supplements and Medicare Advantage Plans.
Medicare Supplement Insurance Plans
(Medigap)
A Medicare Supplement Plan complements original Medicare by covering the portion that Medicare does not pay. Healthcare providers who accept Medicare will also accept a Supplement Plan since they only need to bill Medicare. Medicare covers about 80% of eligible benefits, and the remaining 20% is usually covered by the Supplement Plan. It's essential to understand that Supplement Plans do not include Prescription Drug Coverage (Part D, PDP), and there may be a penalty for those who don't enroll in a PDP when first eligible. While the cost of Supplement Plans may increase over time, the coverage remains consistent year after year.
Medicare Advantage Plans
Medicare Advantage Plans, also known as "Part C" or "MA Plans," serve as a comprehensive alternative to Original Medicare. These plans, provided by private companies authorized by Medicare, integrate Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), along with typically including Medicare drug coverage (Part D). By enrolling in a Medicare Advantage Plan, individuals maintain their Medicare coverage while benefiting from a unified package of healthcare services.