Do you know the difference between the “parts” of Medicare?

There are many important facts you need to understand about Medicare prior to enrolling to make sure you get the most out the available Medicare plans and benefits.

Medicare is a federal health insurance program that pays for a variety of health care expenses. It’s administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services (HHS). Medicare beneficiaries are typically senior citizens aged 65 and older. Adults with certain approved medical conditions (such as Lou Gehrig’s disease) or qualifying permanent disabilities may also be eligible for Medicare benefits.

Similar to Social Security, Medicare is an entitlement program. Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. Even if you didn’t work long enough to be entitled to Medicare benefits, you may still be eligible to enroll, but you might have to pay more.

There are four different parts to the Medicare program. Parts A and B are often referred to as Original Medicare. Medicare Part C, or Medicare Advantage, is private health insurance, while Medicare Part D offers coverage for prescription drugs.

The "Parts" of Medicare

The types of Medicare programs are often referred to as Part A, Part B, Part C, and Part D. Here’s a rundown of what each “Part” is about.

Medicare Part A is hospital insurance. Part A covers inpatient hospital care, limited time in a skilled nursing care facility, limited home health care services, and hospice care.

Most Medicare Part A beneficiaries don’t have to pay a monthly premium to receive coverage under this part of Original Medicare; this is called “premium-free Part A.” Otherwise, you pay a monthly premium.

Medicare Part A does not cover 100% of your hospital bill, so you will be responsible for a share in the cost. When you are first admitted to the hospital, you will be responsible for your deductible. Medicare then pays 100% of your costs up to 60 days. If you are still in the hospital from days 61-150, you will have a daily copay. If you are still in the hospital beyond 151 days, you will be responsible for all costs. You will be eligible for care at a Medicare-approved Skilled Nursing Facility following an inpatient hospital stay of at least 3 days. Medicare will cover all eligible expenses for the first 20 days. From days 20-100, you will be responsible for a daily copay. After day 100, you are 100% responsible for any/all expenses for that facility.

Medicare Part B is medical insurance. Part B benefits cover certain non-hospital medical expenses like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries.

Medicare Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services when requested by your doctor.

Medicare Part C, or Medicare Advantage, insurance often includes every type of Medicare coverage in one health plan. It’s offered by private insurance companies contracted through CMS to provide a Medicare benefits package as an alternative to Original Medicare. Enrolling into a Medicare Advantage plan is optional, but to obtain this private insurance, you must also have Original Medicare, Part A and Part B. You also may have to continue to pay your Part B premium if you have a Medicare Advantage plan.

One of the first things to understand when joining a Medicare Advantage Plan is that you are dis-enrolling yourself from Medicare. Your private insurer of choice will now be your Primary Insurance. A majority of Medicare Advantage plans have a network of doctors and hospitals that they work with. While Medicare Advantage plans are required to provide all Medicare Part A and Medicare Part B benefits (except hospice care), plans can also include different additional benefits, which vary among the individual private health insurers. Many Medicare Advantage plans include prescription drug coverage. Some plans might have a lower deductible, while also allowing you to pay a smaller share of the remaining costs. Medicare Advantage plans may even cover certain health care services that Original Medicare, Part A and Part B, does not cover, like eye exams, hearing aids, dental care, exercise programs or health care received for emergencies while traveling outside the United States.

Medicare Part D is optional prescription drug coverage. Medicare Part D is available as a stand-alone prescription drug plan through private insurance companies, and the monthly fee varies among insurers. You will share in the costs of your prescription drugs according to the specific plan in which you’re enrolled. Those costs can include a deductible, a flat copayment amount, or a percentage of the full drug cost (called “coinsurance”).

If you want Prescription Drug Coverage, you can purchase a “stand alone” plan with a Medicare Supplement or with Basic Medicare. Most Medicare Advantage plans include Prescription Drug Coverage. If you have limited income and cannot afford your medications even though you receive Medicare Part D benefits, you may qualify for the Extra Help program, which offers financial assistance for your monthly premium, deductible, copayment, or coinsurance.

Medicare Options Coral Springs

MedigapSupplement Plans

If you’re concerned about Medicare costs, a Medigap health insurance policy (also called Medigap Supplemental insurance or a Medicare Supplement plan) helps pay the “gap” between what Original Medicare (Medicare Parts A and B) pays and what you pay out of your own pocket. You can get a Medicare Supplement policy through private insurance companies. When you purchase a Medicare Supplement, Medicare remains your Primary Insurance and your supplement would be your Secondary Insurance. The main advantage of a Medicare Supplement over a Medicare Advantage Plan is that Medicare Supplements have no networks. You can go to ANY Doctor, Hospital, or Treatment Facility that accepts Medicare…Nationwide.

What you should know about Medigap

The Medigap policy you purchase must be clearly identified as “Medicare Supplement Insurance.” There are 10 different Medigap coverage options to choose from. Plans are labeled A, B, C, D, F, G, K, L, M, and N . Some carriers even offer an HDF which makes Medicare Supplements another affordable option. Plans with innovative benefits may be available and offered by company.

All insurance companies selling a particular Medicare Supplement plan type in your area must offer the same coverage, but may offer it at different prices. We help you shop for the best price.

You can get a Medicare Supplement plan only if you already have Original Medicare. This would help pay for out-of-pocket costs under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), but it does not cover Medicare Part D (Prescription Drug Plans.)

Because Medigap policies are regulated by state and federal laws, the benefits for all the coverage options are generally the same regardless of insurer. The differences will be in the price, who administers the plan, and which of the 10 options the insurer chooses to offer. Choose a health insurer you trust, and shop around for the best prices.

Open Enrollment Period for Medicare Supplement plans

Your Medigap Open Enrollment Period begins the first day of the month in which you turn 65 and are covered under Medicare Part B. You have seven months to enroll, 3 months before your birthday, the month of, and 3 months after. If you are under 65, check with your state’s Social Security Administration to see if it offers additional open enrollment periods.

Be aware that Medigap plans supplement Original Medicare to fill in cost gaps. If you are considering a Medicare Advantage plan, you can’t use a Medigap plan in conjunction with a Medicare Advantage plan.

As long as you enroll during this seven-month Medicare Open Enrollment Period, the insurance company cannot refuse to sell you a Medicare Supplement policy, charge you more because you have health problems, or make you wait for coverage to begin. If you enroll in a Medicare Supplement plan outside of your Medicare Open Enrollment Period, the private insurance company may “underwrite” the plan. That means you may be subject to a physical, and the insurance company can refuse to sell you the plan or they can adjust your premium based on your health status.

If you enroll into a Medicare Advantage plan, you are not allowed to use and can’t be sold a Medicare Supplement policy. However, if you later return to Original Medicare, Parts A and B, within your first year of joining a Medicare Advantage plan, you may have a special right to sign up for a Medicare Supplement plan.

Medicare can become confusing and overwhelming. We at iWill Advisors educate and guide you through the many different plans, choices and cost considerations. We represent ALL major national insurance companies – not just a single carrier. This difference provides you with a full comparison and the ability to select from more plans that may better suit your coverage and budget needs.

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