Understanding Medicare

Medicare is a federal health insurance program primarily for people age 65 and older, and for individuals under 65 with certain disabilities. It’s divided into different parts, each covering specific services:

Medicare Part A — Hospital Insurance

Part A helps cover:

• Inpatient hospital stays
• Skilled nursing facility care
• Hospice care
• Some home health care

Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare Part B — Medical Insurance

Part B helps cover:

• Doctor visits and outpatient care
• Preventive services (like screenings and vaccines)
• Lab tests and X-rays
• Durable medical equipment

Part B has a monthly premium, which is set annually and may be higher based on your income.

Medicare Part D — Prescription Drug Coverage

Part D helps cover the cost of:

• Prescription medications
• Many common vaccines

You enroll in a standalone Part D plan if you choose Original Medicare (Parts A & B), or you may receive drug coverage through a Medicare Advantage plan that includes drug benefits.

Next Step: Choose How to Get Additional Coverage

Original Medicare (Parts A & B) doesn’t cover everything. Most people choose one of two paths for added benefits and cost protection:

Option 1: Original Medicare + Medicare Supplement Plan (Medigap) + Part D

✅ How it works:

• You keep Original Medicare (Parts A & B)
• Add a Medicare Supplement Plan (also called Medigap) to help cover out-of-pocket costs like deductibles, coinsurance, and copays
• Enroll in a separate Part D plan for prescription drugs

✅ Pros:

• Predictable costs with low out-of-pocket expenses
• Freedom to see any doctor or specialist who accepts Medicare
• No referrals needed

⚠️ Considerations:

• Monthly premiums for Medigap and Part D
• Medigap plans do not include vision, dental, or hearing benefits
• Not all states guarantee acceptance if applying later

Option 2: Medicare Advantage Plan (Part C)

✅ How it works:

• All-in-one plan that replaces Original Medicare
• May include medical, hospital, and drug coverage
• Often includes extras like dental, vision, hearing, gym memberships, and more

✅ Pros:

• Lower or $0 premiums in some areas
• Includes drug coverage in most plans
• Extra benefits beyond what Original Medicare offers

⚠️ Considerations:

• You’ll use a network of doctors and hospitals (HMO or PPO)
• Both PPO’s and HMO’s are available
• Costs like copays and coinsurance can add up depending on usage

Which Option Is Right for You?

Deciding between Marketplace plans, private options, or a health share plan depends on your budget, health needs, and personal preferences. If you’re unsure which is right for you, our licensed agents can help you compare your options and walk you through the enrollment process.