MEDICARE 101 (BASIC FAQS & 101 VIDEOS)

Medicare is the health insurance program provided by the U.S. federal government to people who are 65 & older and younger people with certain disabilities.

When someone says "Original Medicare" they are referring to Medicare Parts A & B, which are run by the federal government.  Part A covers inpatient hospital care, skilled nursing facility costs, hospice, and some home health care services.  Part B covers services like physician or doctor visits, lab tests, diagnostics, durable medical equipment and other outpatient services.  In its simplest form, 95%+ of the time Part A is for inpatient care or for when you are confined somewhere, and Part B is for outpatient care or care that you receive and go home the same day.  

Medicare Part A is provided at no cost to most individuals as long as they or their spouse worked at least 10 years or 40 quarters paying into their FICA or Medicare Taxes. While most Medicare beneficiaries do not pay anything for their Part A, most DO pay for part B.  Part B's cost is adjusted annually and premiums vary by income level. To learn more about the income levels click Here. The standard monthly cost, which most people pay is $164.90 for calendar year 2023.

Medicare Advantage (MA) plans are offered by private insurance companies.  When you enroll into an MA plan this plan becomes your primary payor.  These plans must cover all benefits that Part A & Part B cover with benefits at least as good on average as original Medicare.   MA plans are often viewed as an all-in-one alternative to Original Medicare.  Most MA plans include prescription drug coverage.  Many plans will also give you additional benefits such as dental, vision, and hearing benefits.  These plans may even include additional benefits such as fitness memberships, transportation and even OTC benefits.  

Unlike original Medicare, all Medicare Advantage plans also are required to have out of pocket maximums, or stop losses to limit your "worst case scenario" for covered medical bills.  In most parts of the country MA plans have a very low, or even $0 monthly premium, so they can be very cost effective for the right person.  However, due to unique provider networks, premiums, copays, coinsurance, and out-of-pocket spending limits, MA plan benefits can vary tremendously from plan to plan and insurance company to insurance company.  With that in mind, it is important to speak with an independent insurance professional before enrolling in a MA plan.

*Note, there is NOT a Medicare Part C program that is directly through original Medicare. Anyone claiming your original Medicare card should say Part A, B & C, is deceiving you or is mistaken.

Part D plans are plans that help pay for prescription medications. Just like Part C, Part D plans are only available from private insurance companies.

If you are eligible for Medicare coverage, you are also eligible for the Medicare drug benefit (Part D). You must be enrolled in Medicare Part A and/or entitled to Part B to enroll in Part D.  You must enroll in a Part D plan when you become eligible for one unless you have other credible coverage or you will be penalized for the time you did not have a plan once you elect to enroll in one.  This is not a small one time penalty either, it is a lifetime penalty in most cases.  Credible coverage includes options such as; coverage through you or your spouses employer, or coverage through the Veteran's Administration (VA).  

When selecting a Medicare Part D plan, it is important to "look-up" the medications you are taking to make they are all covered by your plan.  This can be done via the individual insurance companies websites, or plan formularies, or from an all in one lookup tool such as on Medicare.gov or our SmartEnroll system.

*Note: With only a few very minor exceptions you do not need a stand alone Part D, Prescription Drug Plan if you buy a Medicare Advantage plan.  Enrollment in a Part D while you are enrolled in a Medicare Advantage plan may cancel your MA plan.  Please reach out to us if you have specific questions regarding this issue.

Medigap or Medicare Supplement plans are options that are available from private insurance companies to helps pay out-of-pocket costs approved by but not covered by original Medicare's Parts A & B.  These plans are sold by private insurance companies.  If you have a Medigap plan, it will pay part or all of certain remaining costs that Original Medicare leaves behind. These costs may include outstanding deductibles, coinsurance, and copayments.  Medicare Supplements work only with Original Medicare. If you have a Medicare Advantage Plan, you cannot buy a Medigap.

In most states you have up to 10 different Medigap policies to choose from: A, B, C, D, F, G, K, L, M, and N.  Each policy letter offers a different set of standardized benefits. This means that all policies with the same letter name offer the same benefits regardless of what insurance company you purchase it from.  It is still commonly seen as a good idea to review your Medicare Supplement from time to time as premiums can vary from company to company and what was a very competitive costing plan 8 years ago may no longer be.

There are hundreds of "right" answers to this question, but without knowing your individual situation, this question is impossible to answer.  The good news is Medicare Made Simple offers 100% free Medicare reviews and advice.  Call, email, or message us today to speak with a licensed insurance agent who will listen to your individual needs and help you determine not only which avenue may be the right fit, but we will also take the information you tell us to help determine of the hundreds of plans and plan combinations may be the right fit for YOUR INDIVIDUAL needs.  Don't want to talk to anyone?  We also offer free, cutting edge, self service software Here to help you do some of your own research and even self enroll in a plan.