You’ve come to the right place for your Medicare information. We hope you will learn as much as your heart desires and we definitely want to hear from you and want to help you ever step of the way.
Most of us know about Medicare as our parents were and/or are still on it. That being said we will answer this question of What is Medicare, and several other questions like; how does it work? What Does Medicare Cover? What are all of the different Parts of Medicare? This page is more of a general page so we recommend if you have further questions to keep exploring out site as we do go much deeper.
Let’s define Medicare coverage!
Original Medicare is a federal health insurance program that was designed for people 65 and older. Most people think this program is 100% free however, as you will learn this is not the case. There are many different cost associated with this program depending on which product you obtain.
Medicare also helps those individuals that meet specific disabilities guidelines or have been diagnosed with end-stage kidney failure. Medicare is broken down into specific “Parts” and each Part provides different layers of coverage. When you obtain all of the Parts of Medicare together it creates a pretty comprehensive program.
While Original Medicare is comprehensive coverage it does leave behind some gaps in coverage. The great news is there are additional programs that help fill in those gaps. Depending on which direction you go these programs can fill in nearly 100% of the gaps.
Medicare Part A under Original Medicare is your hospital insurance coverage that assists you with the cost of inpatient care. You also also additional coverages that go beyond hospital care such as Hospice, Skilled nursing facilities, and home health care. As you can see this is much more than just Hospital coverage.
For most Americans this coverage Part will come to you at no additional cost as you have already paid for this coverage through your payroll taxes. If you did not work a total of 40 quarters or 10 years you can incur a separate monthly cost. You can log into your Social Security portal to confirm you have all 40 quarters.
Original Medicare covers most of the cost associated with your Part A coverage. There are deductibles and copays that you may have as part of your stay at each of these facilities. If you obtain a Medigap policy or Medicare Advantage plan some if not all of these cost can be paid for up to 100% of the cost.
Medicare Part B covers you for most medical needs that fall outside of Part A coverage Most of us see Part B as your coverage for your primary care Doctor or Specialist, however it provides many other coverages that fall outside of seeing a Doctor.
Some of these services include Outpatient surgeries, Lab work, radiology, CT Scans, MRI, kidney dialysis, cancer therapy and Ambulance services. There are many other services that your Part B coverage will provide medical coverage for.
With the ever changing world of how medical procedures are now done as compared to 20 plus years ago, most people will use their Part B coverage far more then they will use their Part A coverage.
Similar to your Part A coverage your Part B coverage also has coverage gaps that can end up costing you thousands of dollars. This is why it is important to have a Medigap plan or Medicare Advantage plan in place to help fill in the gaps left behind by Original Medicare.
If you would like to learn more about Medicare Part B we recommend that you visit this page. We will take a much more in depth look at Medicare Part B.
Medicare Part C is more commonly known as a Medicare Advantage plan. Your local Medicare Insurance Agent is your main point of contact for signing up for one of these plans. This is not a coverage that you sign up for a your Social Security office but rather is a secondary option that is available to you if you so chose.
Most insurance Agents and people in general define Part C as the Medicare Advantage program. The cost and coverage of a Medicare Advantage plans varies by carrier, State, county of residence, zip code, and plan selected.
Some Medicare beneficiaries will pay as little as $0.00 per month while others could pay as much as a $300 or more per month. This is in addition to the premium you will need to pay towards your Part B monthly premium. For 2021 plan year, your Part B monthly premium is $148.50.
Signing up for both Medicare Part A and Part B is a requirement before you are able to enroll into a Part C plan. It is very important that you continue to pay your Part B premium each month or you will be dis-enrolled from your Medicare Advantage plan.
Unlike Original Medicare with a Medigap plan, Medicare Advantage plans require you to live in the plan service area as most of these plan are considered HMO. Once you enroll into a Medicare Advantage plan, your Medicare coverage will come from the Advantage plan itself, and not from the government or Original Medicare which is a PPO style plan.
You are not required to enroll into a Part C plan and by doing so you give up your rights given to you by Original Medicare. By singing up for a Medicare Advantage plan you agree to allow the Insurance Carrier to decide what is covered and what is not covered.
Many people prefer to get their Medicare coverage from Original Medicare and purchase a separate Medicare Supplement plan aka a Medigap plans. These people do not want a Part C Advantage plan as they don’t want to give up their rights that are proved under Original Medicare, so they will simply not enroll in one. In addition, they prefer to have their Doctor decide what is medically necessary and not the plans network.
It is your choice whether you wish to opt into an Advantage plan as opposed to just staying with your original Medicare A & B and signing up for a Medigap plan.
Medicare Part D provides you with prescription drug coverage. For many year people 65 and older had to take on 100% of the cost associated with their prescription drug cost. This all changed with the roll out of Part D coverage.
While this coverage is not perfect and if you are a heavy user you could incur some pretty expensive bills even with this coverage in place. Congress has made some efforts in reducing down what is known as the donut hole. In our opinion there is still a lot of work that needs to be done.
With this coverage you have several options when it comes to getting your prescritpion drugs. You can either pick up a 30, 60, or 90 day supply at your local pharmacy or you could request mail orders. We recommend evaluating the cost between these two options. Many times you can reduce your cost by ordering through mail orders while other times it will cost you less to pick up your drugs at a local pharmacy.
Medicare Part D can be purchased either on a standalone basis or through a Medicare Advantage plan. If you purchase it through a Medicare Advantage plan you are not allowed to obtain a separate standalone Part D plan.
We love our job and that is because we love our clients. We are here to help you find the right plan option that works best for you. No two people have the same needs when it comes to Medicare needs. Everyones health related needs are all different.
We created this site because if you are like me you want to be prepared. Research is what we love to do for our clients. We spent years working to perfect this website so it can answer most if not all of your questions. We want you to feel confident in our abilities to help you find the best coverage options.
We look forward to hearing from you and/or your family member.