Medicare

An Overview of Medicare

Medicare was established in 1965 as a Federal Program that offers health insurance to people age 65 and over and/or people who may be entitled to or qualify for it. Medicare has 4 parts (A, B, C & D).
Original Medicare consists of part A (Hospital Insurance) and part B (Medical Insurance).

  • Part A (Hospital Insurance) helps cover:
    Inpatient care in a hospital
    Inpatient care in a skilled nursing facility (not custodial or long-term care)
    Hospice Care
    Home health care
    Inpatient care in a religious non-medical health care institution
  • Part B (Medical Insurance) helps cover:
    Medical necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services.
    Many preventative services

Part C (Medicare Advantage Plan) is an “all in one” alternative to Original Medicare. These “bundled plans” include Part A, Part B and usually Part D. Plans may have lower out-of-pocket costs than original Medicare and most plans offer extra benefits that Original Medicare doesn’t cover, like vision, hearing, and dental. In many cases, you’ll need to use doctors who are in the plan’s network.

Part D (Medicare Drug Coverage) helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

There are two ways to get Medicare Drug Coverage:

Medicare drug plans

These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans.  You must have Part A and/or Part B to join a separate Medicare drug plan.

Medicare Advantage Plans or other Medicare health plans with drug coverage

You get all of your Part A, Part B and drug coverage through these plans.  Remember, you must have Part A and B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

MEDIGAP (Medicare Supplemental Insurance) Policies

Another option to consider is A Medigap (Medicare Supplemental Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (like co-payments, co-insurance, and deductibles). If you are in Original Medicare and have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then, your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to obtain a Medigap policy.) Also, a Medigap policy is different than a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Medicare benefits.

We would be happy to speak to you individually with no cost or obligation about your particular situation. Please feel free to contact our Medicare specialist:

Mark Singleton:

440-356-2055

mark.singleton@icg-llc.com

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