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UNDERSTANDING MEDICARE

What is Medicare?

Medicare is the federal health insurance program for:

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance) 

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits.

Medicare Advantage Plans include:

  • Health Maintenance Organizations

  • Preferred Provider Organizations

  • Private Fee-for-Service Plans

  • Special Needs Plans

  • Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan

  • Medicare services aren’t paid for by Original Medicare

Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

  • Some Medicare Cost Plans

  • Original Medicare

  • Some Medicare Private-Fee-for-Service Plans

  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

  • People who are 65 or older

  • Certain younger people with disabilities

  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are Medicare Supplements/

Medigap Policies?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

A Medigap policy is different from a Medicare Advantage Plan.

Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

What you need to know about Medicare Supplements:

  1. You must have Medicare Part A and Part B.

  2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.

  3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.

  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

  5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

  7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

  8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.hbk

Not sure what kind of coverage you have?

  1. Check your red, white, and blue Medicare card.

  2. Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.

  3. Check your Medicare health or drug plan enrollment.

  4. Call Medicare at 1-800-MEDICARE (1-800-633-4227).  

Explore some of our other articles on Medicare

*This Information was provided by: www.medicare.gov

Not connected with or endorsed by the United States government or the federal Medicare program.

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