Help me understand Medicare
A look at Medicare benefits, including Original Medicare as well as supplemental coverage and advantage plans.
Learn More About Medicare Terms & Resources
Get familiar with common insurance terms, Medicare plan types, and additional Medicare resources.
What is Original Medicare?
Original Medicare (often just called “Medicare”) is a federal program that provides health insurance for people 65 and older and people with certain disabilities. Under Original Medicare, you can receive your services from any qualified health care provider in the US who accepts Medicare.
Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance covering doctor visits and treatment).
MEDICARE PART A
What's covered?
- Inpatient services received in hospitals
- Some inpatient care in skilled nursing facilities
- Hospice and some home health care services
What are the costs?
- No monthly premiums for most people
- Hospital admission deductible (per benefit period, which is 60 consecutive days between admissions)
- Copays and coinsurance
- No yearly limit on your out-of-pocket costs
MEDICARE PART B
What's covered?
- Doctor visits
- Outpatient care, like preventative services
- Some services not covered by Part A, like physical or occupational therapy
- Some home health care services
What are the costs?
- Monthly premiums
- Annual deductible
- Copays and coinsurance (often you will pay 20% of cost of covered services)
- No yearly limit on your out-of-pocket costs
DID YOU KNOW?
ORIGINAL MEDICARE (PARTS A & B) DOESN'T COVER EVERYTHING
Original Medicare does not pay 100% of the cost of covered services. There are also things Original Medicare does not cover at all, including prescription drugs, routine eye, dental, foot, and hearing care, long-term care, most care outside the US, and more.
Many people enroll in additional plans to help cover some of these costs.
Additional Coverage Options
Once you enroll in Original Medicare, you can choose to add plan(s) from private insurance companies to help fill some of the coverage gaps and reduce your out-of-pocket costs. These plans include Medicare Supplement/Medigap plans, Prescription Drug (Medicare Part D) plans, and Medicare Advantage (Medicare Part C) plans.
IMPORTANT NOTE: If you sign up for additional plans, you must continue to pay any Part A or Part B monthly premiums.
MEDICARE ADVANTAGE PLANS
(MEDICARE PART C)
There is a wide range of Medicare Advantage plans, so costs, benefits, and your choice of health care provider can vary.
Medicare Advantage plans (also called Medicare Part C) are "all-in-one" plans. With Medicare Advantage plans, you can receive coverage for your Part A inpatient hospital stays, Part B doctor visits, and Part D prescription drugs all in one plan.
They cover everything that Original Medicare covers with extras - including dental, vision, hearing, over-the-counter, and fitness/wellness benefits. They may also cover urgent and emergency care while you travel.
A variety of plan types are offered, including PPO, HMO, HMO-POS, and HMO SNP plans.
MEDICARE PRESCRIPTION DRUG PLANS
(MEDICARE PART D)
Original Medicare does not include Part D prescription drug coverage (for drugs you would normally get at a pharmacy). If you want prescription drug coverage, you must either buy a standalone Part D Prescription Drug plan from an insurance company contracted with Medicare, or you can enroll in a Medicare Advantage plan that includes Part D benefits.
You pay a monthly premium, deductibles, and copayments or coinsurance with stand-alone plans and with some Medicare Advantage plans.
MEDICARE SUPPLEMENT PLANS
("MEDIGAP" PLANS)
Medicare Supplement plans (also called “Medigap” plans) help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some also cover services Original Medicare doesn’t, like care outside the US.
Supplement/Medigap plans do not cover prescription drug costs, so you can also buy a Part D Prescription Drug plan. Monthly premiums for Supplement/Medigap plans are typically higher than those charged by Medicare Advantage plans.
How to Enroll in Additional Plans
There are two paths you can take to get additional coverage. Both begin with the first step of enrolling in Original Medicare. Here is a look at the steps you will need to take.
STEP ONE
Enroll in Original Medicare when you become eligible.
What's Covered?
The government-provided Original Medicare plan...
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covers hospital |
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covers doctor and |
STEP TWO
Then, choose from two paths to add more coverage:
Supplement/
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Medicare Advantage Plans
Medicare Advantage These plans include Medicare Parts A and B, plus more. The Part D Prescription Drug Plan is included with most plans.
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HOW TO GET AFFORDABLE, FULL HEALTH CARE COVERAGE
If you want one health plan that includes Parts A and B, plus Part D Prescription Drug coverage and more, choose a Generations Advantage plan.
Still have questions? Get in touch with us today.
Let’s talk about your health needs and how our plans help you keep doing the things you love. Call us today to find out more about Martin’s Point Generations Advantage plans.