Help me understand Medicare.
A look at Medicare benefits, including Original Medicare, supplemental coverage options, and Medicare Advantage plans.
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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 are "all-in-one" plans. With MA 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—dental, vision, hearing, over-the-counter, and wellness benefits. They may also cover urgent and emergency care while you travel.
A variety of plan types are offered, including PPO, LPPO, HMO, and HMO-POS plans.
MEDICARE PRESCRIPTION DRUG PLANS
(MEDICARE PART D)
Original Medicare does not include Part D prescription drug coverage. To get prescription drug coverage, you must either buy a standalone Part D Prescription Drug plan from an insurance company contracted with Medicare, or enroll in a Medicare Advantage plan with Part D benefits.
You pay a monthly premium, copays/coinsurance, and deductible costs with stand-alone plans as well as with some Medicare Advantage plans.
MEDICARE SUPPLEMENT PLANS
("MEDIGAP" PLANS)
Medicare Supplement plans help pay some of the health care costs and services that Original Medicare doesn’t cover, such as copayments, coinsurance, deductibles, and care outside the US.
These plans do not cover prescription drug costs. 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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Common Medicare FAQs
Eligibility and enrollment
Learn the ins and outs of Medicare eligibility periods, enrollment, and assistance programs you may quality for.
Medicare and employment
More people than ever before are deciding to delay their Medicare enrollment and continue to get their health insurance through their employer. While working past 65 can help you put away additional savings for retirement, you could inadvertently be penalized for not enrolling in Medicare at the proper time. Before you make this important decision, you should know what the impact could be.
We’ve put together the following information to help you better understand your options.
IF YOU ARE COVERED ON YOUR EMPLOYER'S HEALTH PLAN
Speak with your benefits administrator to see how your employer’s plan works with Medicare. You may be required to enroll in Original Medicare Parts A and B when you turn 65. Many people only enroll in Part A (hospital coverage with no premium) and delay enrollment in Part B until they lose employer coverage. Contact your Social Security office to make sure your enrollment decisions are followed.
Keep records of any prescription drug coverage you receive from your employer after you turn 65. You may need proof of this when you eventually enroll in Medicare to avoid penalties.
WHEN YOU FIRST GET MEDICARE (INITIAL ENROLLMENT PERIOD)
Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.
IF YOU ARE ON AN INDIVIDUAL HEALTH PLAN
You could save money if you switch to a Medicare plan with additional coverage.
There are specific times when you can sign up for plans or make changes to coverage you already have. Each year you'll have a chance to review your coverage and change plans.
WHEN YOU FIRST GET MEDICARE (INITIAL ENROLLMENT PERIOD)
Most people are first eligible to enroll in Original Medicare when they turn 65. Your seven-month-long “Initial Enrollment Period” begins three months before the month you turn 65 and ends three months after. You must be a US citizen or legal resident who has lived in the US for at least five years in a row.
DURING CERTAIN TIMES EACH YEAR (ANNUAL ENROLLMENT PERIODS)
Annual Enrollment Period for Medicare Advantage and Medicare prescription drug coverage: Every year Medicare offers an “Annual Enrollment Period,” from October 15 to December 7, when you can add, drop, or switch your enrollment for the following plan year.
Medicare Advantage Open Enrollment Period: Medicare offers a “Medicare Advantage Open Enrollment Period” from January 1 to March 31 each year. During this period, if you’re already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan. You can also disenroll from your Medicare Advantage plan and return to Original Medicare and join a Medicare Part D Prescription Drug plan (if you choose to do so).
SPECIAL CIRCUMSTANCES (SPECIAL ENROLLMENT PERIODS)
Medicare also offers “Special Enrollment Periods” when you can make enrollment changes if certain circumstances change (for example, if you lose employer coverage, move to a new service area, or would like to switch to a plan that has earned a 5-Star quality rating from Medicare.)
When you become eligible, begin the enrollment process with the Social Security Administration:
- If you start collecting Social Security benefits before you turn 65, Social Security should enroll you in Original Medicare (Parts A and B) automatically. They will mail your Medicare card to you three months before your 65th birthday.
- If you don’t receive your Social Security card or you haven’t enrolled in Social Security, visit or call your local Social Security office or go to the SocialSecurity.gov website.
There are several state and federal programs that provide assistance with Medicare costs for Part A, Part B, and Part D. Eligibility varies by state and is determined by income and assets.
You can contact the Social Security Administration online, call 1-800-772-1213 (TTY/TDD: 1-800-325-0778), or visit your local Social Security office to see if you are eligible.
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.
Isn’t your health worth a conversation?
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.