Understand Your Medicare Options | Medicare Consultant

New to Medicare?

LEARN ABOUT YOUR OPTIONS

Your Medicare Coverage Choices

You have choices in how you can get your Medicare coverage.
Ask Carol B will review each of your options in detail.

Your Medicare Coverage Options

There are two main ways to get your Medicare coverage – Original Medicare with add-on Drug and Medicare Supplement Plans OR Medicare Advantage.

Original Medicare

Includes Hospital (Part A) and Medical (Part B) Insurance.
If you want drug coverage, you can add a separate Drug plan (Part D).
You can also add a Medicare Supplement Insurance (Medigap) policy to help pay your out-of-pocket costs.
You can use a doctor or hospital that takes Medicare, anywhere in the U.S.

Medicare Advantage Plan

An all-in-one alternative to Original Medicare, also known as Part C.
These “bundled” plans include Part A, Part B, C and usually Part D.
Most plans offer extra benefits – like vision, hearing, dental, gym memberships and more.
Must use doctors and hospitals in the plan’s network (for non-emergency or non-urgent care).

Original Medicare

This coverage includes:

Part A premium: Usually $0 cost / month

Standard Part B premium: $170.10* / month

YOU CAN ADD:

Part B (Medical Insurance)

Helps cover:

Services from doctors and other health care providers
An annual wellness visit
Many preventive services, like flu shots
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
Some health programs, like smoking cessation and obesity
Physical, occupational and speech-language therapy
Diabetes screenings, education and certain supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs, walkers, hospital beds, and other equip
Ambulatory surgery centers, ambulance and emergency room services

YOU CAN ALSO ADD:

Original Medicare is a federal health insurance program for eligible U.S. citizens and legal residents. It is funded in part by the FICA taxes you pay while working. It is individual health insurance that generally has a cost for each service. Here are the general rules for how it works: In most cases you can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients. With a few exceptions, most prescriptions aren’t covered in Original Medicare. You can add drug coverage by joining a Medicare Drug Plan (Part D). In Original Medicare you don’t need to choose a primary care doctor or get a referral to see a specialist.

You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket. Part B has a premium and if your income is over a certain threshold, you may have to pay an additional amount called an IRMAA. You generally don’t need to file Medicare claims. The law requires providers and suppliers to file your claims for the covered services and supplies you get. Providers include doctors, hospitals, skilled nursing facilities, and home health agencies.

THINGS TO KNOW:

Original Medicare

Part A and Part B only covers about 80% of the cost for most medical bills. There is also a deductible for each Part.
There is no yearly limit on your out-of-pocket costs. That’s where Medigap comes in to bridge that gap.
If you don’t sign up for Part B when you’re first eligible, you may pay a late enrollment fee, unless you qualify for a Special Enrollment Period.
Medicare Part A: Your out-of-pocket costs include the Part A benefit-period deductible and coinsurance for the services you receive.
Medicare Part B Your out-of-pocket costs include the Part B calendar-year deductible, coinsurance for the services you receive any charges that exceed the Medicare-approved amount.

Medicare Supplement (Medigap or Med Supp)

You can buy a Medicare Supplement Insurance (Medigap) policy to help pay your Original Medicare out-of-pocket costs.
If you want this type of coverage and don’t buy a Medigap policy when you’re first eligible, you may go through underwriting.

Prescription Drug Plan (PDP)

If you want drug coverage, you can add a separate Drug plan (Part D).
If you don’t join a Drug plan (either through a stand-alone Drug Plan or through MedicareAdvantage) when you first get Medicare, you may pay a penalty for a long as you have Medicare drug coverage.

* Rate for 2022. Most people pay the Standard B premium amount. If your modified AGI (Adjusted Gross Income) as reported on your IRS tax return from 2 years ago is above a certain amount, we will need to send you the chart outlining the extra charge added to your premium called IRMAA.

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Medicare Advantage Plan

This coverage includes:

Part A premium: Usually $0 cost / month

Standard Part B premium: $170.10* / month

Medicare Advantage Plan: $0.00-$depends on your zip code

Part B (Medical Insurance)

Helps cover:

Services from doctors and other health care providers
An annual wellness visit
Many preventive services, like flu shots
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
Some health programs, like smoking cessation and obesity
Physical, occupational and speech-language therapy
Diabetes screenings, education and certain supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs, walkers, hospital beds, and other equip
Ambulatory surgery centers, ambulance and emergency room services

A Medicare Advantage Plan is another way to ge your Medicare Part A and Part B coverag. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white and blue Medicare card in a safe plave because you’ll need it if you ever switch back to Original Medicare.

If you join a Medicare Advantage Plan, you’ll still have your Medicare but you’ll ge most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

THINGS TO KNOW:

Medicare Advantage Plan

All of your Part A and Part B benefits are provided by Medicare-approved private carriers.
There is a yearly limit on your out-of-pocket costs. You will pay co-pays, co-insurance and have deductibles.
If want this type of coverage and you don’t join a Medicare Advantage Plan when you first get Part A and Part B, you may have to wait for the next yearly Open Enrollment Period to join.

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Medicare Supplement Plan

This coverage includes:

Part A premium: Usually $0 cost / month

Standard Part B premium: $170.10* / month

Medicare Advantage Plan: $0.00-$depends on your zip code

Need a Stand-alone Prescription Drug Plan in addition

Part B (Medical Insurance)

Helps cover:

Services from doctors and other health care providers
An annual wellness visit
Many preventive services, like flu shots
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
Some health programs, like smoking cessation and obesity
Physical, occupational and speech-language therapy
Diabetes screenings, education and certain supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs, walkers, hospital beds, and other equip
Ambulatory surgery centers, ambulance and emergency room services

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental services, hearing aids, eyeglasses, or private-duty nursing.

Medigap plans are standardized. Medigap must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” plan, identified in most states as plans A – D, F, G and K – N. All plans offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap plans are standardized in a different way.

THINGS TO KNOW:

Medicare Supplement (Medigap or Med Supp)

You can buy a Medicare Supplement Insurance (Medigap) policy to help pay your Original Medicare out-of-pocket costs.
If you want this type of coverage and don’t buy a Medigap policy when you’re first eligible, you may go through underwriting.
This can help pay some of the out-of-pocket costs not paid by Medicare Part A and Medicare Part B.

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Prescription Drug Plan

This coverage includes:

Part A premium: Usually $0 cost / month

Standard Part B premium: $170.10* / month

Medicare Advantage Plan: $0.00-$depends on your zip code

Part B (Medical Insurance)

Helps cover:

Services from doctors and other health care providers
An annual wellness visit
Many preventive services, like flu shots
Clinical laboratory services, like blood and urine tests
X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
Some health programs, like smoking cessation and obesity
Physical, occupational and speech-language therapy
Diabetes screenings, education and certain supplies
Mental health care
Durable medical equipment for use at home, like wheelchairs, walkers, hospital beds, and other equip
Ambulatory surgery centers, ambulance and emergency room services

Medicare drug coverage (Part D) helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join the plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage.

To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.

There are 2 ways to get Medicare drug coverage (Part D):

Medicare drug plans.

These plans add Medicare drug coverage (Part D) to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans. You must have Part A and / or Part B to join in a separate Medicare drug plan.
Medicare Advantage Plans or other Medicare health plans with drug coverage.

You get your Part A, Part B, and Medicare drug coverage (Part D) through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

In either case, you must live in the service area of the plan you want to join and be lawfully present in the U.S.

THINGS TO KNOW:

Prescription Drug Plan (PDP)

If you want drug coverage, you can add a separate Drug plan (Part D).
If you don’t join a Drug plan (either through a stand-alone Drug Plan or through MedicareAdvantage) when you first get Medicare, you may pay a penalty for a long as you have Medicare drug coverage.

New to Medicare?

Your Medicare Coverage Choices

Your Medicare Coverage Options

Original Medicare

Medicare Advantage Plan

Original Medicare

Part A (Hospital Insurance)

Medicare Supplment Plan (Medigap)

Part B (Medical Insurance)

Part D (Prescription Drug Plan - PDP)

Original Medicare

Medicare Supplement (Medigap or Med Supp)

Prescription Drug Plan (PDP)

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Medicare Advantage Plan

Part A (Hospital Insurance)

Drugs

Part B (Medical Insurance)

Vision, Hearing, Dental and More

Medicare Advantage Plan

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Medicare Supplement Plan

Part A (Hospital Insurance)

Medicare Supplment Plan (Medigap)

Part B (Medical Insurance)

Medicare Supplement (Medigap or Med Supp)

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

Prescription Drug Plan

Part A (Hospital Insurance)

Drugs

Part B (Medical Insurance)

Vision, Hearing, Dental and More

Prescription Drug Plan (PDP)

source: Mediacare.gov

Our Team is here to walk you through the Medicare Maze. Learn about when you can join a plan, switch plans and what Medicare covers.

There is no commitment and our services are 100% free.

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