YOUR GUIDE TO MEDICARE
Medicare can be confusing. But you’ve got this. And we’re here to help. Whether you’re new to Medicare or just want a refresher, use this guide to help you understand what’s best for you.
Medicare at a Glance
|PART A + PART B|
Prescription Drug Plans
Medicare Supplement Plans
Medicare Advantage Plans
|What’s Covered:||Federal program that generally covers 80% of the cost of medical expenses.||Can be added to Original Medicare to help pay for your drug coverage.||Most plans limit out-of-pocket costs for care and offer more coverage than Original Medicare||Combines Part A, Part B and usually Part D coverage. Often offers extra benefits as well.|
|Hospital Insurance |
|Limited annual Out-of-Pocket Expenses||✓||✓|
Parts A & B
When you turn 65, have a qualifying disability or end stage renal disease (ESRD), you’re eligible for PART A and PART B – that’s Original Medicare.
HOSPITAL INSURANCE (PART A)
- In-patient care in a hospital
- Limited stays in a skilled nursing facility
- Some home health care
- Hospice care
Most people don’t pay a Part A premium because they paid Medicare taxes while working.
MEDICAL INSURANCE (PART B)
- Doctor’s services
- Outpatient care
- Some preventive service
- Some prescription drugs
Part B is optional and has a monthly premium. There is a penalty if you don’t enroll when first eligible. In most cases, you can delay enrollment in Part B without penalty if you are actively at work and enrolled in an employer group health plan.
There are some out-of-pocket costs you’ll pay with Parts A and B.
|Deductibles and copays for hospital stays|
|Part B annual deductible|
|20% of the Medicare-approved amount for most care you get from doctors or other health care providers, outpatient therapy, Medicare Part B drugs and durable medical equipment.|
|Routine dental care|
|Routine vision care eyewear|
|Routine hearing exam and hearing aids|
You can sign up during these 7 months. If you plan to work past age 65, these times can differ for you:
Before your Birthday
During your Birthday Month
After your Birthday
When You Need More Coverage
You may want more than Original Medicare gives you. That’s where your plan options come in.
- Medicare Supplement
- Medicare Part D – Prescription Drugs
- Medicare Advantage Part C
Covering Medicare Gaps
Medicare Supplement plans help limit out-of-pocket costs and offer more coverage than Original Medicare. Private insurance companies sell them. Monthly premiums are usually based on age.
- You can go to any doctor or hospital that accepts Medicare
- Options with low – or no – copays or coinsurance for a visit to the doctor or a stay in the hospital.
You can sign up for a Medicare Supplement plan without answering health questions during your Medigap Open Enrollment Period. This six-month period begins on the first day of the month in which you’re 65 or older AND enrolled in Part B. If you sign up after this period, you might have to answer health questions.
Medicare Part D
Prescription Drug Coverage
Original Medicare (Part A or B) doesn’t cover most prescriptions. You can get Medicare Part D plans from a private insurance company.
Part D plans add extra coverage.
|PART B Coverage||PART D Additional Coverage|
|Injections you get in a doctor’s office||Prescription drugs|
|Certain oral anti-cancer drugs||Biological products|
|Immunosuppressant drugs||Vaccines licensed under Public Health Service Act|
|Under limited circumstances, certain drugs you get during hospital outpatient treatment||Medical supplies associated with insulin injections, including syringes, needles, alcohol swabs and gauze|
|Drugs used with some durable medical equipment (like a nebulizer or external infusion pump)||A copay of $35 or less for select insulin drugs through the Senior Savings Model with some plans|
|You pay 20% of the Medicare-approved amount for these covered drugs. And the Part B deductible applies||You pay a copay or coinsurance for these covered drugs. The amount you pay is based on the plan you choose|
Information on Costs
These plans vary in costs from company to company and year-to-year. You might encounter:
- Copays and coinsurance
- Monthly premiums
- Annual deductibles
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify, you can call your local Social Security office.
Late Enrollment Penalty
You may have to pay a late-enrollment penalty if you don’t join a Medicare Part D drug plan when you are first eligible for Medicare and go without credible prescription drug coverage for 63 continuous days or more.
Medicare Part C
Medicare Advantage Plans
Some plans combine medical, hospital, and may also include prescription drug coverage, with extra benefits. That means you get all your Medicare benefits in a single, all-in-one plan. Private insurance companies offer these plans. You’ll still pay your Medicare Part B premium every month.
- Options with $0 monthly premium
- Out-of-pocket maximums
- Extra benefits like vision, dental and hearing
You can sign up for a Medicare Advantage plan when you sign up for Original Medicare and during other periods.
|Initial Coverage Election Period (ICEP)|
A 7-month opportunity surrounding your initial Medicare eligibility.
|Annual Enrollment Period (AEP)|
October 15 – December 7
|Medicare Advantage Open Enrollment Period (MA OEP)*|
January 1 – March 31
|Special Enrollment Period (SEP)|
Based on a qualifying event, such as loss of coverage, moving to a new area, etc.
Supplement or All-in-One
A Closer Look
Everyone’s needs are different. Let’s look at Medicare Supplement and Medicare Advantage plans side-by-side so you can see what might work best for you.
|Medicare Supplement||Medicare Advantage|
|Age-based premiums||Flat premium, regardless of age|
|Deductibles, copayments and coinsurance||Deductibles, copayments and coinsurance|
|No Part D prescription drug coverage||May include Part D prescription drug coverage|
|Standardized benefits||Benefits vary|
|Accepted by any Medicare Provider||Uses a provider network|
|Can change at any time during the year||Limited enrollment periods|
|May have to answer health questions and may have a pre-existing waiting period||No Health questions and no pre-existing waiting period|
|May require additional prior authorizations for services|
|May offer additional services including personalized support|
|May offer reminders to keep you on track to complete preventive services|
Making Your Decision
What’s Right for You
It’s important to pick coverage that works for you. Here are important things to consider when researching your options:
It’s a good idea to keep the following expenses in mind:
- Monthly Premium
- Copays, coinsurance, deductibles and maximum out-of-pocket
- Your prescription drugs
Check to see if the plan includes:
- The hospital and health care facilities you use
- Your Primary Care Provider
- Any specialists you see
- Your pharmacy
Does the plan give you any extras?
- Fitness membership
Let's Get In Touch!
119 N Maple Street- P.O. Box C
Cole Camp, MO 65325
Disclaimer: By responding to this advertisement, I understand a sales agent may contact me by telephone, email or mail to discuss Medicare Advantage and Prescription Drug plans, and Medicare Supplement Insurance Plans. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.