Medicare

What is Medicare?

Medicare is a fee-for-service health care program for seniors, in which the government pays health care providers directly for services that fall under Parts A and B of Medicare benefits (see below). However, if you are looking for more coverage than Original Medicare, you can purchase one of our Medicare Advantage Plans to receive all your Part A and Part B benefits.¹

Medicare is divided into four categories. This allows you to customize your personal coverage when shopping for a comprehensive policy.

• Part A (hospital insurance): Covers hospital care, emergency services, nursing home care, home health services and hospice.
• Part B (medical insurance): Covers medically necessary services and supplies used for diagnosing and treating medical conditions, and preventative services for illness prevention and/or early detection. Examples include ambulance services, mental health care, outpatient procedures and clinical research.
• Part C: Combines Parts A and B and often part D as well.
• Part D: Offers prescription drug coverage.

What Medicare options are available?

Original Medicare offers coverage for services and supplies that are considered to be medically necessary, such as doctor visits, lab tests and wheelchairs. There are several alternative plans you can choose from for additional coverage, and each plan must offer at least the same coverage as Original Medicare. There are two Medicare plans that we can assist you with.

1. A Medicare Advantage Plan, also known as Part C, combines Part A and Part B as a replacement to Medicare for more comprehensive health care coverage. This plan can be customized with additional coverage, such as a prescription drug program (Part D), vision and dental.
2. A Medicare Supplemental Plan, also known as Medigap, has a higher premium but supplements the coverage gaps and deductibles that Part A and Part B leave behind.

Why do you need Medicare?

Seniors are in the most need of health care, but once retired monthly premiums can become hard to maintain. Enrolling in the Medicare program allows you to get the care you need for a minimal charge.

Contact us today to learn more about coverage options. We are happy to work with you to determine which Medicare options works best for you.

Medicare Advantage plans work different than Medicare Supplement plans, and they are divided in to 2 major groups, HMO's and PPO's. Although very similar in features and benefits, the mechanics of how this plans work are very different than Medigap plans.

First and foremost, there are no networks on a Medigap plan, where on an Advantage plan you will have a network of doctors and hospitals and depending upon which plan you select , you may need to stick strictly to the network.

The biggest difference between an HMO and a PPO is that on an HMO you will have to strictly to the doctors in the network, you will have to select a primary doctor, and your primary doctor will be the one that will have to give you a referral to go to any specialist, but the upside of the HMO's is that most of the times the copays to see doctors or to go to the hospitals will be lower than on the PPO's. In contrast the PPO's are more flexible in the sense that you will not need to select a primary doctor or a specialist, you can simply select any doctor within the network and go without the need of a referral, and in certain cases you can even go to some doctors that are not part of your network as long as the doctor is willing to accept the plan terms and conditions, but you will pay a higher copay in most cases and perhaps even a deductible for doctors that are out of network.

The other significant difference is that in most Medigap plans there are no copays whatsoever, were on the Medicare Advantage plans you have to pay co-payments for many things such as hospitalizations, doctors visits, diagnostic testing such as MRI's Cat scans, physical therapy, and Chemo.

For more information or questions, call us at 888-801-9097

1 - This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

Additional Resources

Out of Pocket Costs of Medicare Advantage

2020 Medicare News

Medicare for All or Single payer explained

DIFFERENCE BETWEEN MEDIGAPS AND MEDICARE ADVANTAGE PLANS

Video Explaining Difference Between Observation Status and Inpatient Status: