Medicare

• Part A: Hospital Insurance – most people don’t have to pay a Part A premium, which helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B: Medical Insurance – most people pay a monthly premium for Part B, which helps cover doctor’s services, outpatient care, medical supplies, and many preventative services.

You can choose to receive your Medicare benefits in various ways:

• Original Medicare
• Original Medicare + Supplement OR Cost Plan + Part D
• Medicare Advantage
  • An “all in one” alternative to Original Medicare is Medicare Advantage (Part C). These “bundled” plans include Part A, Part B, and usually Part D.
  • If you join a Medicare Advantage Plan, you will still pay your Part B premium. However, you will get your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.

Watch this short video to learn more about Medicare basics.

Medicare Supplement insurance, also known as Medigap, is sold by private insurance companies and supplements Original Medicare Parts A and B. These policies cover gaps in Original Medicare Parts A and B such as co-payments, coinsurances, and deductibles you would otherwise pay yourself. Most Medicare Supplements do not have a network and you will continue to pay your Part B premium. Premiums are typically based on age and can increase as the insured gets older.

Medicare Select Supplements are typically lower-cost versions of traditional Medicare Supplements, but they require members to use in-network facilities for Part A services. By negotiating prices within the network, Medicare Select Supplement carriers are able to keep their costs down.

Medicare Advantage Plans are another way to obtain your Medicare benefits. Also known as “Part C,” these plans are offered by Medicare-approved private insurance companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you will get most of your Medicare Parts A (Hospital Insurance) and B (Medical Insurance) benefits from the plan, not Original Medicare.  Many Medicare Advantage Plans offer additional benefits not available through Original Medicare such as routine dental, vision, and hearing. Premiums are not based on the age of the insured and you will continue to pay your Part B premium.

The Annual Enrollment Period (AEP), October 15 through December 7, is the time to review and/or change coverage for the upcoming year. The annual Medicare Advantage Open Enrollment Period (MA-OEP), January 1 through March 31, is an additional enrollment period for current Medicare Advantage enrollees to make a one-time selection into a different Medicare Advantage Plan or return to Original Medicare. Special Enrollment Periods (SEP) are available year-round with a qualifying event.

Medicare Advantage Plans can be a solution for Veterans. With Original Medicare Parts A & B, Veterans still have financial exposure when receiving services outside the VA system. Medicare Advantage Plans cap your out-of-pocket risk and add benefits Original Medicare or the VA may not offer such as dental, vision, and hearing services. Some plans also offer a Part B premium reduction.

Cost Plans are somewhat of a hybrid – a cross between a Medicare Supplement and a Medicare Advantage Plan. Similar to Medicare Advantage, Cost Plans have a network of doctors and hospitals, and there may be some cost sharing. Copays and coinsurance track towards an out-of-pocket maximum to limit the annual risk for the insured.

Cost Plans may include additional benefits not covered under Original Medicare such as routine dental, vision, and hearing. The rates do not vary based on age, and are generally less expensive than a supplement. Some Cost Plans may offer an optional prescription drug rider to fulfill your creditable prescription drug requirement. You will continue to pay your Part B premium.

As with a supplement, members retain Original Medicare, ensuring coverage if services are received outside the plan’s network. When obtaining healthcare services, show both your Original Medicare and Cost Plan cards.

Cost Plans in our area typically allow year-round enrollment and are not medically underwritten (with the exception of end-stage renal disease). 

Medicare Prescription Drug Plans, also known as “Part D,” help pay for prescription costs. Anyone with Medicare Part A and/or B is eligible for prescription drug coverage.

You can obtain coverage through a stand-alone Prescription Drug Plan (PDP), Medicare Advantage Prescription Drug Plan (MAPD), or a Cost Plan if available. You may have creditable drug coverage through an employer-sponsored plan. Knowing whether your coverage is creditable is important in order to avoid penalties.

The Annual Enrollment Period (AEP), October 15 through December 7, is the time to review and/or change coverage for the upcoming year. Special Enrollment Periods (SEP) are available year-round with a qualifying event.