Understanding Your Core Medicare Coverage

Understand the foundational parts of Medicare:

Medicare Part A (Hospital Insurance): This covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Keep in mind that Part A has a deductible, and after 60 continuous days in the hospital, copays may apply.

Medicare Part B (Medical Insurance): This covers a range of outpatient medical services, including doctor visits, preventative care (like annual wellness exams), and durable medical equipment. Typically, Original Medicare (Part A and Part B combined) covers about 80% of these services.

Exploring Your Plan Options

Now, let’s explore your plan options to help cover the remaining costs:

Medicare Supplement Insurance (Medigap): Helps pay for out-of-pocket costs not covered by Original Medicare, such as the Part A deductible and Part B coinsurance (the 20% you’d typically pay).

Additional Coverage: Some Medigap plans also cover excess charges under Part B.

Monthly Premiums: These plans typically have a monthly premium.

Medicare Part D (Prescription Drug Plan): If you choose a Medigap plan, you’ll typically need to enroll separately in a Medicare Part D plan for outpatient medications.

Nationwide Freedom: Medigap plans let you see any doctor or hospital nationwide that accepts Medicare.

Medicare Advantage (MA) Plans (Part C): An “all-in-one” alternative to Original Medicare that bundles Part A, Part B, and usually Part D.

Private Insurance: Offered by private insurance companies that contract with Medicare.

Network-Based: Often limited to providers within a network (like HMO or PPO).

Premiums and Cost-Sharing: May have lower premiums but include copays and deductibles for services received throughout the year.

Extra Benefits: Often include vision, dental, hearing, and other benefits not covered by Original Medicare.

Medicare Part D: Most MA plans include drug coverage in one convenient plan.

Finding the Right Fit for You

Choosing the Medicare plan option that best suits your individual healthcare needs and budget is an important decision. Talk to a licensed agent who can guide you through each option and help you make an informed choice.

Special Enrollment Period (SEP)

Experienced a life-changing event (e.g., losing employer coverage, moving, or changes in Medicaid eligibility)? You may qualify for a SEP to enroll outside the standard windows.

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