Medicare.....Where Do I Start?

Let’s start with the basics. What are the different parts of Medicare?

Part A (Hospital Coverage)

• Part A covers hospital stays and skilled nursing facilities after a hospital stay. It also assists with some home-bound skilled care and hospice care.

• You can choose any qualified provider in the USA who accepts new Medicare patients.

• When it comes to Part A there are some coverage limits. If you are hospitalized or are in a skilled nursing facility for more than 90 days, you may have to pay for part of the costs.

• Under Part A Doctor services in the hospital are not covered.

• You will not pay a premium for Part A if you or your spouse have contributed to Social Security for at least 10 years which is 40 quarters.

To summarize coverage for Part A:

• Hospital care

• Skilled nursing facility care

• Nursing home care (as long as custodial care isn't the only care you need)

• Hospice

• Home health services

Part C (Medicare Advantage)

Medicare Advantage plans (Part C) are run by private insurance companies. These plans combine coverage for certain hospital costs, doctors visits and other medical services. Many of the medicare advantage plans also include prescription drug coverage.

• All covered under one plan.

• Dependent on the plan, you can choose a primary care doctor or you can visit a provider who accepts the plan’s terms, conditions and rates.

• Part C plans have appointed service areas and nationwide emergency coverage.

• Coverage limits vary according to the different plans.

• Part C plans cover the same services as Part A and B except for hospice care under Part A.

• Your share of costs include:

  • Premiums which will vary on plan and company.

  • Deductibles may or may not exist in certain plans. In addition, many medicare advantage plans charge copays and/or coinsurance.

  • For prescription drugs, you may be subject to a coverage gap.

Now that we have an understanding of what the different components of Medicare are lets look at what options' someone has when they get on Medicare.

Step 1

 When eligible, enroll in Original Medicare.

• Part A – Covers hospital stays

• Part B – Covers doctor and outpatient visits

        STEP 2

(YOU HAVE 2 OPTIONS!)

Option 1

Keep Original Medicare and enroll in:

• Medicare Supplement (Medigap) Insurance covers all or some costs not covered by Original Medicare.

                                     and/or

• Part D – covers prescription drugs. These plans are offered by private companies.

Choosing between Option 1 or Option 2 isn't always easy. There are some questions to think about:

1. Do I want to have referrals to go to a specialist?

2. Do I want to be able to go to any doctor and hospital I want?

3. How expensive would my medications be on a stand alone prescription drug plan vs a medicare advantage plan?

4. If I travel often does that affect the options I have?

5. What am I able to afford?

6. Am I healthy or do I have chronic conditions?

Here at Angelakos Financial Services our consultants will help think about these questions explain how your answers will affect the options you have available to you. Our consultants will not only explain your health insurance options, but also the avenues available for financial assistance through government programs. 

Below are some videos which may also be found in our Learning Center to further explain the topics above.

different parts of medicare

• Medicare is for:

  • People age 65 or older

  • People with disabilities who may be under 65 or even older than 65

  • People who have End-Stage Renal Disease (ESRD)

• Parts of Medicare include: A,B,C,D

Understanding your medicare choices

• Medicare Supplement policies are also known as Medigap policies

• Original Medicare and Medicare Advantage plans both have Part A and Part B coverage

• Part A is free for most people

• Part B has a monthly premium