Confused about Medicare? Start here.

May 6, 2021

Understanding Medicare: Part 1 of 6

If you’re finding it challenging to navigate Medicare, you’re not alone. That’s why we’re launching a multi-part series to clear up the facts and help people like you make informed choices about their health care coverage. In part one, we begin with an overview of Medicare and a look at your choices.

First, the basics

Medicare is the health insurance program provide by U.S. government for people age 65 and up and people with disabilities. Medicare has different components or parts, which can be confusing. It helps to start with the fact that you essentially have two choices for Medicare coverage. One is Original Medicare. The other is Medicare Advantage.

(You can also choose to purchase additional insurance, called a Medicare Supplement plan, to help cover some of health care costs not covered by Original Medicare. We’ll look at this option in detail in Part 2 of this series.)


What is Original Medicare?

Think of Original Medicare as your most basic option. Provided by the federal government, it includes coverage for hospital visits (known as Part A) and coverage for visits to doctors and specialists (known as Part B). It doesn’t cover prescription medications, worldwide emergency care, dental care, or other health-related expenses like eyeglasses and contact lenses, hearing, and fitness.

Most people do not have to pay a monthly cost or premium for Medicare Part A, but must meet a deductible for each benefit period. There is also a graduated coinsurance cost if you need to stay in the hospital for more than 60 days. For Part B, most people pay a monthly premium and are responsible for an annual deductible. After that, most people pay a percentage of the Medicare-approved amount for services and equipment. (For more cost details, click here.)

With Original Medicare, you can get care from any provider or hospital that accepts Medicare.

What is Medicare Advantage?

The key thing to remember is this: Medicare Advantage plans cover everything Original Medicare covers, along with more benefits to help you live the life you want.

Medicare Advantage is provided by private health care companies that have been approved by Medicare to offer Medicare coverage. Often called Part C, MA or all-in-ones, Medicare Advantage plans include Parts A and B, plus extras like eye wear and dental benefits. Many MA plans also and include prescription drug coverage (also known as Medicare Part D).

With a Medicare Advantage plan, you pay out-of-pocket costs directly to the doctor, care center, or hospital. Federal Medicare pays Medicare Advantage companies for providing Original Medicare benefits to its members.

 

The Medicare Advantage safety net

Along with extras that help keep health care dollars in your pocket, Medicare Advantage plans also come with a valuable buffer. They set copayment fees or coinsurance — a percentage of the overall cost — for the services they cover. Plus, there’s a limit on how much you’ll pay in a single year. If your plan’s limit is $5,500 and you spend $5,500 on health care with three months to go, your plan picks up the costs for the rest of year for your Part A and B expenses (hospital and medical).

With Original Medicare, on the other hand, there’s no annual cap. That means the amount you pay in deductibles and cost-shares can keep climbing all year.

If you opt for Medicare Advantage, you choose a health care company like Martin’s Point,  and a plan — a particular set of benefits and costs. Martin’s Point offers a whole family of Medicare Advantage plans called Generations Advantage that includes HMOs, HMO-POS, and PPO options. This variety makes it easy to find a plan that fits your particular budget, health needs, and preferences.

Whichever plan you choose, your Medicare Advantage plan has to follow Medicare’s rules – there’s no room for scams. Each Medicare Advantage company is approved and contracted by Medicare, and paid to manage Medicare benefits.

Shopping around? Know what to look for.

With hundreds of Medicare Advantage plans to choose from, it’s important to know what you’re shopping for. Keep these key points in mind: 

  • Total cost. While Original Medicare requires you to meet deductibles, Martin’s Point Generations Advantage plans have no medical deductibles, which helps you control what you pay out of pocket. Sometimes your copay is as low as $0. In addition, Generations Advantage plans cap the amount you’ll ever pay in a single year, helping you plan and preventing worry.

  • Choice. Different plans have different rules about which health care providers you can see, often requiring you to seek care from providers and facilities that are part of their network (in other words, on an approved list). Our Generations Advantage network is noted for a scope that gives members extensive choice.

  • Quality. Each year, Medicare rates all Medicare Advantage plans based on member feedback and information from plans and health care providers. Plans earn 1 to 5 stars, with 5 as the highest rating. Martin’s Point Generation Advantage has the only 5-star plans available in Maine and New Hampshire for 2021, so you can choose them with confidence.

 

We’re here to help

Look for Part 2 in our Medicare series for a deep dive into the differences between Medicare Advantage plans and Medicare Supplement insurance – coming soon.

To learn more about Generations Advantage Medicare Advantage plans from Martin’s Point right now, download our Medicare Made Simple Guide, visit our website, or call 1-800-603-0652 (TTY: 711). There’s no time like the present!