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Knowing the basics of Medicare is important because it can help you make informed decisions when it comes to selecting coverage, utilizing your coverage and understanding the costs associated with Medicare. Knowing the basics of Medicare can also help you understand what services are covered, when to enroll, and who is eligible.
Medicare Part A (hospital insurance) and Part B (medical insurance) are known as Original Medicare. Together, these parts cover an array of inpatient and outpatient services, like:
If you or your spouse paid Medicare taxes during your working years, you may get Part A premium-free. But you’ll still need to pay the Part B premium.
Medicare Supplement plans, also called Medigap policies, are extra insurance that add to your Original Medicare benefits. Original Medicare doesn’t cover everything. Depending on your health, you could still pay deductibles, copays, and coinsurance — out of pocket — when you receive services. Medicare Supplements are meant to fill in these “gaps” in coverage, and some even cover foreign travel emergency care and Medicare excess charges.
The plans are A, B, C, D, F, G, K, L, M, and N — each covering a percentage of benefits. Plans F and G offer high-deductible versions, meaning you have to meet the deductible amount before the plan pays anything. As of 2024, the deductible is $2,800.
However, Plans C and F are not available like they used to be. Those eligible for Medicare before 2020 will continue to have the option to enroll in these Medigap plans later on. This is due to the Medicare Access and CHIP Reauthorization legislation that prohibits supplements from covering the Medicare Part B deductible.
Medicare Advantage, also called Part C, are plans offered by private insurance companies approved by Medicare. These plans are required to provide the same benefits as Original Medicare, and some may have additional coverage, such as fitness programs, transportation, wellness services, dental, vision, hearing, and even prescription drugs.
You must be enrolled in both Parts A and B, and then you may enroll in an Advantage plan.
There are many Advantage plans to explore:
Veterans with TRICARE and VA benefits may also enroll in a Medicare Advantage plan — which extends their health coverage beyond the VA networks.
Medicare Part D is the prescription drug benefit. Beneficiaries can purchase this coverage in two ways: 1) As a separate, standalone plan with Original Medicare or 2) As an additional benefit with a Medigap plan or some Advantage plans like PFFS, MSA, or a Medicare cost plan.
Part D plans, often called PDPs, need to cover a minimum of two drugs within each of these classes:
Each plan has a list of drugs it covers called a formulary. So, the insurance company who provides the plan decides which drugs in each category will be covered. You should check the formulary of the plan you’re applying for to make sure your medications are included.
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Depending on where you live, there may be dozens of Medicare Advantage, Supplement, and prescription drug plans. How do you know which is right for you?
An experienced agent will walk you through your options and help you make an informed decision! And it comes at no additional cost. Call us today for FREE Medicare help.
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