Medicare can be confusing, but it’s not as complicated as you may think. Our specialists can help you know the basics. Let’s start from square one.
What Is Medicare?
Medicare is a federal health insurance program that has 4 parts: A, B, C, and D.
Part A: Hospital
Part B: Medical
Part C: Medicare Advantage
Part D: Prescription Drugs
Parts A and B form “Original Medicare”, which the federal government provides.
Parts C and D are medical and prescription drug plans. Private insurers offer them — not the federal government. To learn what each Part covers, view our website.
Am I Eligible for Medicare?
You’re eligible for Medicare if you are age 65 or older, are under 65 and have specific disabilities, or have end-stage renal (kidney) disease.
Once you’re eligible for Medicare, you’ll have some options about the kind of coverage you want:
Original Medicare (Parts A and B)
Medicare Advantage (Part C)
Medicare Prescription Drug Plans (Part D)
Do I Need to Apply for Parts A and B?
You don’t need to apply if you already receive Social Security benefits or railroad retirement checks when you first become eligible. If you don’t get either of these, contact Social Security three months before you turn 65 to sign up. Even if you don’t plan on retiring at 65, you can sign up for Medicare.
What Is Medicare Advantage?
Original Medicare doesn’t pay for everything. If you decide not to keep Original Medicare, you can enroll in a Medicare Advantage (Part C) plan. This includes all the coverage of Parts A and B, plus Part D, and more. The extra benefits vary by plan.
A Medicare Advantage plan may interest you if you want:
Easy to use, all-in-one coverage
An affordable alternative to Parts A and B
Healthcare coverage with an annual cap on out-of-pocket medical expenses
Original Medicare vs. Medicare Advantage
Here’s how they differ:
You can visit any doctor or hospital that accepts Medicare.
You must buy a separate Part D plan if you need or want prescription drug coverage.
It doesn’t have a cap on how much you pay out of pocket every year.
Medicare Advantage (Part C) Plan:
Has a network of doctors and hospitals that you might have to use.
It can include prescription drug coverage, so you wouldn’t NEED to buy a separate Part D plan.
It limits your annual out-of-pocket expenses to protect your finances.
If you stay with Original Medicare, you may consider adding a Medicare Supplement (Medigap) plan to help cover out-of-pocket expenses, like copays, coinsurance, and deductibles. You pay a monthly premium for Medicare Supplement plans, which are lettered A through N.
Common Insurance Terms
Here are some key insurance terms. Understanding them can allow you to get the most from your plan’s benefits.
Coinsurance: Usually a percentage (like 20%), this is what you pay for covered medical services or prescription drugs after paying your deductible.
Copayment (copay): Usually a set amount (like $20), this is what you pay for covered medical services or prescription drugs.
Cost sharing: What you pay for covered services or prescription drugs. It may include your copay, coinsurance, and deductible.
Deductible: What you pay for covered medical services or prescription drugs before your plan begins to pay.
Maximum out of pocket (MOOP): The most you pay during your plan’s policy period — usually one year — for covered medical services. Once you hit your MOOP, your plan pays 100% of covered medical services. Your premium doesn’t count toward your MOOP.
Network pharmacy: A pharmacy that signed a contract with your plan. Your plan may only cover your prescription if you fill it at a network pharmacy.
Network provider: A healthcare provider, such as a doctor, hospital, or facility, that signed a contract with your plan.
Premium: What you pay your plan every month for medical or prescription drug coverage.
Prior authorization: Requires you or your physician to get permission from your plan before it covers a medical service or prescription drug.
Total drug cost: What both you and your plan pay for a prescription drug that is covered.
Contact a Medicare Expert
If you need help choosing the best Medicare plan, trust an agency with a proven track record. Shannon Speir is an expert when it comes to helping you understand your benefits. Contact us online or call (918) 623-2476 for expert Medicare help.