UNDERSTANDING MEDICARE
Original Medicare is Medicare Part A and Part B. Medicare Part A helps pay for hospital stays and inpatient care. Part B helps pay for doctor visits and outpatient care. After you enroll in Original Medicare, there are two ways to get additional coverage. Option 1 – add one or both (Medicare Supplement and/or Medicare Part D Plan) to Original Medicare. Option 2 – Choose a Medicare Advantage plan.
MEDICARE SUPPLEMENTS
Medicare Supplement Insurance (Medigap) policies are sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, 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. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are an alternate way to get Medicare benefits, while a Medigap policy only supplements your Original Medicare. Medicare-Approved Amount = In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.
All Medicare Supplement companies are required to provide standardized benefits for each plan available, all of which are labeled with a different letter. The differences are in the company, pricing, and / or additional value-added services.
PART D – PRESCRIPTION DRUG COVERAGE
There are 2 ways to get Medicare prescription drug coverage:
- Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and / or Part B to join a Medicare Prescription Drug Plan.
- Medicare Advantage Plans (like HMOs or PPOs) or other Medicare health plans that offer Medicare prescription drug coverage. You get all your Part A, Part B and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember you must have Part A and Part B to join a Medicare Advantage Plan, and not all these plans offer drug coverage.
Important Note: Failing to enroll in Part D coverage when you are first eligible could result in a lifelong penalty upon enrollment.
MEDICARE ADVANTAGE PLANS (PART C)
These plans offer all the benefits that Original Medicare Parts A and B provide and sometimes include Part D Prescription Drug benefits, hearing exams or hearing aids, routine dental are, eye exams, eyeglasses or contacts lenses, and wellness benefits such as gym memberships. Medicare Advantage plans are offered by private insurance companies approved by Medicare. The following definitions are for different types of Medicare Advantage Plans.
HMO – Health Maintenance Organization With this type of plan you must receive care through a network of local doctors and hospitals. Your primary care provider (PCP) oversees your care.
PPO – Preferred Provider Network – With this type of plan, you have access to a local network of doctors and hospitals. Plus, you can see providers out-of-network, generally at a higher cost, if they participate in Medicare and accept the plan.
PFFS – Private Fee for Service – You can go to any Medicare-approved doctor, other health care approved provider, or hospital that accepts the plan’s payment terms and agrees to treat you. This type of plan MAY or MAY NOT include Part D prescription drug coverage.
How We Can Help
At Hartman Insurance Services we strive to empower you to make informed decisions regarding your Health and Life Insurance. Before you meet with one of our agents, we want to verify that your doctors and medications are covered. We encourage you to jot down the doctors you see and the prescriptions you take so your agent can verify that they are covered by the plan. Click here to download your checklist. We also require a signed Scope of Appointment before coming to your scheduled appointment at our office.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get all your options.
Call us at 260-483-2305 to get scheduled with one of our agents who can help educate you on the options that will be best fit for you