Confused About Medicare?

New to Medicare? Confused about your current plan or need a complimentary review?

What is Medicare:

Medicare is a federal health insurance program primarily for people aged 65 and older, as well as some younger individuals with disabilities or specific medical conditions. It is divided into four parts:

Parts of Medicare:

  • Part A (Hospital Insurance): Covers hospital stays, skilled nursing care, hospice, and some home health services.

  • Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

  • Part C (Medicare Advantage): Private insurance plans that combine Part A, Part B, and often Part D, plus extra benefits.

  • Part D (Prescription Drug Coverage): Helps pay for prescription medications, available through private insurers.

Medicare Advantage

Medicare Advantage (Part C) plans are an alternative to Original Medicare (Part A and Part B), offered by private insurance companies approved by Medicare. These plans bundle hospital (Part A) and medical (Part B) coverage and often include additional benefits like prescription drug coverage (Part D), dental, vision, and hearing services.

Key Features of Medicare Advantage Plans:

  • Coverage: Includes everything in Original Medicare plus potential extra benefits.

  • Provider Networks: Often use HMOs or PPOs, meaning you may need to use in-network doctors and hospitals.

  • Costs: Monthly premiums vary (some plans have $0 premiums), but out-of-pocket costs depend on the plan.

  • Eligibility: Available to those enrolled in Medicare Parts A and B.

  • Annual Changes: Benefits, costs, and provider networks can change yearly.

Medicare Supplements

A Medicare Supplement (Medigap) plan is private insurance that helps cover out-of-pocket costs left by Original Medicare (Parts A & B), such as copayments, coinsurance, and deductibles.

Key Features of a Medicare Supplement:

  • Works with Original Medicare, not Medicare Advantage.

  • Covers gaps like hospital and doctor visit costs not fully paid by Medicare.

  • Standardized plans (A, B, C, D, F, G, K, L, M, N) with different levels of coverage.

  • Monthly premium required, in addition to the Part B premium.

  • No drug coverage—requires a separate Part D plan.

Prescription Drugs

A Medicare Prescription Drug Plan (Part D) helps cover the cost of prescription medications. These plans are offered by private insurance companies approved by Medicare.

Key Features:

  • Available as a standalone plan for those with Original Medicare or included in some Medicare Advantage (Part C) plans.

  • Covers different medications based on a formulary (drug list), which varies by plan.

  • Monthly premium required, along with potential deductibles and copays.

  • Has coverage phases, including:

    • Deductible Phase (you pay full price up to a limit).

    • Initial Coverage Phase (you pay a copay/coinsurance).

    • Catastrophic Coverage (lower costs after spending a certain amount).

  • Late enrollment penalty if you don’t sign up when first eligible and don’t have other creditable drug coverage.