Understanding Medicare

Not Sure About Medicare? We Have The Answers

WHAT IS MEDICARE?

Medicare is the government-run insurance program for those 65 or older or people with certain disabilities or end-stage renal disease (permanent kidney failure).

MEDICARE HAS 4 PARTS.

Part A: Hospital coverage
• Inpatient hospital stays
• Skilled nursing facility stays
• Hospice care
• Some home health care
Part B: Medical coverage
• Doctor visits
• Outpatient care
• Some home health care

Part C: Medicare Advantage

Part D: Prescription drug coverage

WHAT IS ORIGINAL MEDICARE?

Original Medicare is the traditional Medicare program managed by the federal government. It includes Part A and Part B coverage but doesn’t cover all of your healthcare costs.

Provider options: Original Medicare doesn’t have a provider network, so you can see any doctor in the U.S. who accepts Medicare.

Typical costs: You pay a deductible, copays, or coinsurance for services. Most people pay a monthly premium for Part B, but you usually don’t pay a premium for Part A if you or your spouse paid Medicare taxes while working.

WHAT IS MEDICARE ADVANTAGE?

Medicare Advantage plans (also called Part C plans) replace Original Medicare and are sold by private insurance companies. All Medicare Advantage plans include Part A and Part B coverage. They often include Part D coverage and extra perks, like fitness benefits and wellness programs. This way, you have one easy package for all of your healthcare needs and cut back on paperwork because you deal with only one company.

Provider options: Medicare Advantage plans have networks of trusted doctors who contract with them to offer lower prices to members. These doctors work closely with the plan to coordinate your care. Some plans allow you to go out-of-network, but you typically save money staying in-network.

Typical costs: Depending on your plan, you may pay a deductible, copays, or coinsurance for services. You pay a monthly premium to your private insurance company, unless you’re on a $0 premium plan. You also continue to pay your Part B premium. Most people don’t have to pay for Part A.

WHAT IS MEDICARE SUPPLEMENT?

Medicare Supplement plans (also called Medigap plans) are sold by private insurance companies and help you pay for costs after Original Medicare pays its share. You have Medicare Supplement in addition to having Original Medicare.

Medicare Supplement plans don’t include extra benefits beyond what Original Medicare covers. And they don’t include prescription drug coverage, so you must buy a prescription drug plan in addition to Medicare Supplement if you need drug coverage.

Provider options: Medicare Supplement doesn’t have a provider network, so you can see any doctor in the U.S. who accepts Medicare.

Typical costs: You pay a deductible, copays, or coinsurance for services. You pay a monthly premium to your private insurance company in addition to your Medicare Part B premium. Most people don’t have to pay for Part A. Because these plans don’t include Part D coverage, you may also need to pay premiums to a private company that sells stand-alone prescription drug plans.

PLAN COMPARISON

Original Medicare
• Managed by federal government
• Parts A and B
• No provider network

Medicare Advantage
• Managed by private companies
• Replaces Original Medicare
• Parts A and B
• Part D pharmacy coverage
• Extras, like fitness perks, wellness programs, and hearing aid benefits
• Provider network to help you save money and get personalized care

Medicare Supplement
• Managed by private companies
• Adds to Original Medicare coverage to pay for more of your healthcare costs
• Parts A and B
• No provider network