Meicare Basics

Medicare 101 - Learn the Basics

  Medicare is a federal insurance program that provides  guaranteed health insurance  for people age 65 and older and for younger people who   qualify because of a disability . More commonly known as original Medicare or traditional Medicare, the program refers to the first two parts of Medicare, Part A and Part B.  Medicare eligibility  isn’t based on your income or assets, and you can’t be denied coverage or charged more because of existing medical conditions. With original Medicare, you can use any doctor or other provider in the United States that  participates in the program . More than 95 percent of surgeons, as well as some 90 percent of Non pediatric physicians, 80 percent of most other specialists and 60 percent of psychiatrists, are accepting new Medicare patients. Medicare isn’t free, you’ll find that original Medicare has fees similar to private-sector insurance you probably had during much of your work life.  For the most part Original Medicare does not include prescriptions.  To get coverage for prescriptions you must sign up for a Medicare Part D plan.  If you don't sign up for a prescription plan when first eligible there will be penalty for enrolling late.  Original Medicare (Parts A and B) can be signed up for through the social security office, Part D can be signed up for through a insurance agent or a carrier. 

    Medicare Part A (Hospital Insurance):

      Part A Covers:

• Hospitals
• Skilled Nursing Facilities
• Hospice
• Some Outpatient Home Health Care

     Part A is free if you have worked and paid Medicare taxes for at least 10 years.  Some may be eligible because of your current or former spouses work. 

  Medicare Part B (Medical Insurance):

    Part B Covers:

• Services from doctors and other health care providers
• Outpatient Care
• Home Health Care
• Durable Medical Equipment
• Some Preventive Services

    Most people pay a premium for Part B, typically $164.90 in 2023 and $174.70 in 2024.  Higher earners can expect to pay more.

  Deductible.  You must pay this predetermined amount of out-of-pocket costs before your Medicare coverage kicks in. In 2024, the Part A deductible is $1,632 per benefit period and the Part B deductible is $240.

  Copayment.  After you meet your deductible, you’ll pay a fixed dollar amount for certain services and supplies.

  Coinsurance.  Also after you meet your deductible, you’ll pay a set percentage of certain bills, such as 20 percent of the cost for most Part B services.

Medicare Advantage Plans - What's the Advantage?     For a Medicare Advantage Plan you must be signed up for Original Medicare Parts A & B and you will still have to pay the Part B premium.  Medicare Advantage Plans are offered by private insurance companies and must provide at least as much as original Medicare and most often offer additional benefits such as dental, vision, hearing and fitness at no additional premium charge.  Many of the Medicare Advantage Plans also include Part D Prescription Plans in them. 

      What do Medicare Advantage plans cover?

All Medicare Advantage (Part C) plans cover:

• All Medicare Part A (hospital) benefits (hospice coverage may be provided, but if not, will still be covered by Part A)*
• All Medicare Part B (medical) benefits

  Most Medicare Advantage Plans Cover:

• Prescription drugs 

Additional benefits Medicare Advantage plans may offer: 

• Dental exams, cleanings and X-rays
• Eye exams, eyeglasses and corrective lenses
• Hearing tests and hearing aids
• Wellness programs and fitness memberships
• Other extra benefits such as transportation to medical appointments and virtual provider visits
  *Even if you have a Medicare Advantage plan, hospice care will still be paid for you by Original Medicare Part A. 

Important things to remember about Medicare Advantage plans  

• Some plans will have provider networks, some will not
• Out-of-pocket cost limitations can vary by plan
• Plan premiums can vary by plan, with different ones offered to fit different budgets

General features of Medicare Supplement insurance plans

• Predictable costs help you stay ahead of unexpected out-of-pocket expenses.
• No network restrictions mean you can see any doctor who accepts Medicare patients.
• You don't need a referral to see a specialist.
• Coverage goes with you anywhere you travel in the U.S.
• There is a range of plans available to fit your health needs and budget goals.
• Purchasing a Medigap plan and a Medicare Part D prescription drug plan could give you more complete coverage.
• Guaranteed coverage for life* means your plan can't be canceled.

    How do Medicare Supplement insurance plans work with Original Medicare?

      Medicare Supplement plans work alongside your Original Medicare coverage to help cover some of the costs you would otherwise have to pay on your own. These plans, also known as "Medigap", are standardized plans. Each plan has a letter assigned to it, and offers the same basic benefits. The basic benefit structure for each plan is the same, no matter which insurance company is selling it to you. Note: The letters assigned to Medicare Supplement plans are not the same things as the parts of Medicare. For example, Medicare Supplement Plan A is not the same as Medicare Part A (hospital insurance). 

   What Does Medicare Supplement Insurance Cost?
     The primary goal of a Medicare Supplement insurance (Medigap) plan is to help cover some of the out-of-pocket costs of Original Medicare (Parts A & B). As a general rule, the more comprehensive the coverage, the higher the premium, however, premiums will also vary by insurance company, and premium amounts can change yearly.