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Navigating Medicare Made Easy

Understanding the Different Parts

Medicare is divided into Parts each covering different aspects of healthcare (hospital insurance, medical insurance, Medicare Advantage, and prescription drugs, respectively). Understanding the coverage and benefits of each part can be confusing.

Estimating Out-of-Pocket Costs

Calculating and predicting out-of-pocket expenses, including premiums, deductibles, copayments, and coinsurance, can be challenging.

Confusing Terminology

Terms like “donut hole,” “formulary,” “copayment,” and “coinsurance” can be difficult to understand, leading to misinformed decisions.

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Understanding how Medicare works, the coverage and benefits of each part can be confusing.

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care
  • Rehabilitation care
  • Skilled long-term care
  • Hospice care

Original Medicare Part B, provides 80 percent coverage for a wide range of medically necessary services and supplies, including:

  • Preventive care services
  • Outpatient care
  • Primary care physician visits
  • Durable medical equipment
  • Mental healthcare
  • Laboratory tests
  • X-rays and other diagnostic tests

Medicare Part C, also known as Medicare Advantage Plans, are Medicare health plans offered by private insurance companies. These plans typically combine the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance) with prescription drug coverage, all in one plan, which is then an MAPD plan.

Medicare Part D, helps cover the cost of prescription drugs; it is offered by private insurance companies.

  • Medicare Part D premiums are paid directly to the private insurance company.
  • Medicare Part D does not cover all prescription drugs, and it does not cover drugs that are NOT medically necessary.
  • Plans change every year, so it is wise to seek out a local insurance agent .

Medicare Supplement Plans, also known as Medigap Plans, are a type of insurance which help cover the gaps not covered by Original Medicare. These costs include Part A and B deductibles, copayments, and coinsurance.

  • Medicare supplement plans are federally regulated standardized plans, which means they must follow certain rules set by the federal government.

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care Hospice care
  • Rehabilitation care
  • Skilled long-term care

 

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care Hospice care
  • Rehabilitation care
  • Skilled long-term care

 

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care Hospice care
  • Rehabilitation care
  • Skilled long-term care

 

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care Hospice care
  • Rehabilitation care
  • Skilled long-term care

 

Original Medicare Part A, provides coverage for medically necessary:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home healthcare services
  • Acute care Hospice care
  • Rehabilitation care
  • Skilled long-term care

 

Frequently Asked Questions

What is Original Medicare?

Original Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). It consists of Part A (Hospital Insurance) and Part B (Medical Insurance).

What are Medicare Advantage Plans?

Medicare Advantage Plans, also known as Part C, are an alternative way to get your Medicare benefits. These plans are offered by private companies approved by Medicare and must provide at least the same benefits as Original Medicare, but may offer additional benefits such as vision, hearing, and dental coverage.

How does Medicare Part D work?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover the cost of prescription drugs and may help lower your drug costs and protect against higher costs in the future.

What is Medigap?

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Medigap policies can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles.

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