Understanding Medicare

In order to be eligible for Medicare, at least one of the following requirements must be met:

Parts of Medicare

Medicare Part A: Assists people with hospital expenses
Medicare Part B: Assists people with doctor and other outpatient costs
Medicare Part C: Is known as Medicare Advantage and allows people to receive their Medicare A and B benefits for a private insurance company
Medicare Part D: Assists people with prescription drug expenses

Medicare Part A and B

Known as Original Medicare, it helps pay for hospital and medical services. Beneficiaries receive their benefits directly from the government under Original Medicare. The government pays the doctor or the hospital directly for the services received by the beneficiary.

Medicare Part A assists beneficiaries with expenses such as inpatient care in hospitals, this included critical access hospitals and inpatient rehabilitation facilities. Other expenses covered include hospice care; if certain requirements are met it will help with some home health care and skilled nursing facilities (custodial and long-term care is not included).

Medicare Part B assists beneficiaries with expenses such as doctors visits and certain services not covered under Medicare Part A like physical therapy or occupational therapy. Other services that may be covered include preventive services, and in certain cases, medically necessary home health care services.

Medicare Part C

Medicare Part C is commonly known as Medicare Advantage and gives beneficiaries another way of receiving their benefits from Medicare A and B. This option allows the beneficiary to receive their benefits from a private insurance company instead of the government.

These plans provide all the benefits from Medicare A and B and in many instances they offer extra coverage for other medical services. Medicare Part D is included in many of the Medicare Advantage Plans to cover prescription drugs.

The different types of Medicare Advantage Plans include:

Medicare Health Maintenance Organization (HMOs)
HMO plans consist of a network of doctors and health care providers that agree to provide services for a set monthly payment from Medicare.

Preferred Provider Organizations (PPO)
A PPO is similar in nature to an HMO. The main difference is beneficiaries of a PPO do not need referrals to see specialist providers outside the network. This allows them to see any doctor or provider that accepts Medicare. These limit how much one will pay for care outside of the network.

Private Fee-for-Service Plans
These plans offer a Medicare approved private insurance plan. Once you have this Medicare pays the plan for Medicare approved services while the Private-Fee-for-Service plan determines, up to a limit, how much the recipient of the care will pay for covered services. The difference between what Medicare will pay and what the PFFS charges will be the responsibility of the beneficiary.

Medicare Special Needs Plans
These plans provide health care for people with more specific conditions. If a person joins one of these, they receive healthcare services along with more focused care to manage a specific disease or condition.

Medicare Part D

Medicare Part D is prescription drug coverage insurance ran by private insurance companies or other private companies approved by Medicare.

Medicare Supplements are plans from private insurance companies designed to provide coverage for the deductible amount and the coinsurance amount required to be paid by the Medicare recipient.

How to get a Medicare supplement:

1. Enroll in Medicare Part A and B
2. Contact us to find out which plan is best for you.
3. Enroll into your Medicare Supplement.

Annual enrollment period is October 15th - December 7th You can enroll in Medicare Advantage plans 3 months before and after your 65th birthday or the annual enrollment period You can enroll in a Medicare Supplement 6 months before and after your 65th birthday or during the annual enrollment period.