Have questions about Medicare?
You’re not alone! The information below will help you better understand the basics and find answers to common Medicare questions.
What is Medicare?
Medicare is a federal health insurance program for:
– People aged 65 and older
– Individuals under 65 with certain disabilities
– People of all ages diagnosed with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
Types of Medicare Coverage:
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance) and is administered by the federal government.
Medicare Advantage (Part C) and Prescription Drug Plans (Part D) are offered by private insurance companies approved by Medicare.
What is Medicare Supplement (Medigap)?
Medicare Supplement Insurance, also known as Medigap, helps cover the costs that Original Medicare doesn’t—such as copayments, coinsurance, and deductibles. Medigap plans are sold by private insurance companies and are not part of the federal Medicare program.
Medicare Can Be Confusing
Let Us Help You Understand & Get You What You Need
What Does Medicare Part A Cover?
- Inpatient hospital care
- Inpatient care at a skilled nursing facility
- Hospice care services
- Home health care services
How Part A Works:
You can choose any doctor, specialist, or hospital that accepts Medicare—no referrals needed. However, deductibles, copayments, or coinsurance costs may apply for the services you receive.
Do You Pay for Part A?
Most people age 65 or older do not pay a monthly premium for Part A. If you or your spouse paid Medicare taxes while working for at least 40 quarters (about 10 years), you qualify for premium-free Part A.
Instead of enrolling in Original Medicare (Part A and Part B), you can choose to join a Medicare Advantage Plan, also known as Part C.
- Offered by private insurance companies approved by Medicare
- Available in all 50 states
- Different from fee-for-service plans like Original Medicare
With a Medicare Advantage Plan, Medicare pays a set amount each month to the insurance company to manage your care—whether or not you use services that month.
Medicare Prescription Drug Plans help lower the cost of most generic and many commonly used brand-name medications.
You have two ways to get prescription drug coverage:
- Enroll in a stand-alone Prescription Drug Plan (PDP) offered by private insurance companies approved by Medicare.
- Choose a Medicare Advantage Plan (MAPD) that includes prescription drug coverage.
All Prescription Drug Plans must meet Medicare’s minimum coverage standards. However, costs and the list of covered drugs (known as a formulary) can vary from plan to plan.
What Does Medicare Part B Cover?
- Medically necessary doctor visits and services
- Outpatient care
- Home health services
- Durable medical equipment (like walkers, wheelchairs, and oxygen equipment)
- Many preventive services, such as screenings and vaccines
How Part B Works:
You can see any doctor or specialist who accepts Medicare—no referrals needed, just like with Part A.
Do You Pay for Part B?
Most people age 65 or older pay a standard monthly premium for Part B.
Many Medicare Advantage Plans offer extra benefits not included with Original Medicare, such as:
- Vision care
- Hearing services
- Dental coverage
- Health and wellness programs
Part C plans are available in two main forms:
- Medical Only (MA) – covers medical services
- Medical + Prescription Drug Coverage (MAPD) – covers medical services and prescription drugs
Types of Medicare Advantage Plans:
SNP (Special Needs Plans)
HMO (Health Maintenance Organization) Plans
PPO (Preferred Provider Organization) Plans
PFFS (Private Fee-for-Service) Plans
MSA (Medical Savings Account) Plans
A Medigap Plan helps cover the “gaps” in Original Medicare (Parts A and B), such as:
- Deductibles
- Copayments and coinsurance
- Excess charges
Medigap policies are sold by private insurance companies licensed in your state. They work alongside Original Medicare, paying their portion after Medicare pays its share of the bill.
Some Medigap plans also offer additional benefits not covered by Original Medicare, such as coverage for emergency care while traveling outside the United States.
Why It’s Important to Review
Your Drug Plan Each Year
- Drug Formularies Can Change:
Plans may add or remove medications from their covered list, affecting your out-of-pocket costs. - Premiums and Copays May Increase:
Monthly premiums, deductibles, and pharmacy copayments can change from year to year. - Your Health Needs May Be Different:
New prescriptions, health conditions, or changing medication needs could make another plan a better fit. - Pharmacy Networks Can Shift:
Some plans change their preferred pharmacies, which could impact where you can get the best pricing. - Plan Benefits and Rules Can Update:
Coverage rules like prior authorization or quantity limits may be added or adjusted.
✅ Taking time to review your options during the Medicare Annual Enrollment Period (October 15 – December 7) could save you money — and ensure you’re getting the best care possible.
