We understand that Medicare can be confusing, but it does not have to be. Our experienced agents are trained to answer all of your Medicare questions, so if you do not see the answer to your questions below, please feel free to give us a call at 1-888-970-2940 to get the answers you need to make the best choice for your Medicare insurance needs.
Q: What is “Original Medicare” and how does it work?
This is one of the most common questions we get. It’s also a great question because you need to understand how Original Medicare works to understand your coverage options.
Medicare is a national health insurance program in the United States that is designed for people 65 and older, as well as younger people who have certain disabilities or conditions. “Original Medicare” refers to two specific types of coverage that are offered through the federal government: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Part A is free for most people; Part B requires you to pay a monthly premium based on your income level.
These two plans together help you limit your out-of-pocket costs for many inpatient and outpatient services.
Q: What options do I have to limit my potential out-of-pocket expenses?
Once you have signed up for Medicare Parts A and B, there are two common solutions for additional insurance coverage
Medicare Advantage Plans (Part C). If you have enrolled in Medicare Parts A and B, you are eligible to select the optional coverage of a Medicare Part C plan, also known as Medicare Advantage. These are private insurance plans that replace the Part A and Part B coverage you otherwise would have received from the federal government and place some further limits on the amount of out-of-pocket expenses for which you could be held responsible.
- Medicare Advantage plans can also include other coverages, like prescription drug plans, or dental, vision, or hearing coverage that is not available through Original Medicare. They tend to provide what seems like more comprehensive coverage in “one stop” solution.
- The amount of coverage offered by these plans varies greatly, so it is extremely important to understand all the terms of the plan if you select this option.
- Medicare Advantage plans can be less expensive than Medicare Supplement Plans, with some even offering $0 premiums. If you stay healthy, your out-of-pocket costs are minimal. However, if you get sick, you can actually end up paying more under a Medicare Advantage plan because the cost for services used is often higher.
- Many of these plans require you to use their specific networks, which can limit your treatment options, so pay close attention to any limitations on where you will be “in network” to avoid unexpected costs in the future.
Medicare Supplement Plans: If you have enrolled in Medicare Parts A and B, you are also eligible for a Medicare Supplement (also known as “Medigap”) insurance policy. A private insurance company provides supplemental insurance to help limit your out-of-pocket expenses. Under these plans, you will still receive the Part A and Part B coverage directly from the federal government.
- The coverage available in Medicare Supplement plans is limited to 10 available plan types labeled A, B, C, D, F, G, K, L, M and N. The level of coverage in each of these plans is pre-set by the federal government, which makes it easier to compare the plans across providers. Plan N from one insurance company provides the same coverage as Plan N at every other insurance company.
- With a Medicare Supplement, you can go to any doctor that accepts Medicare, giving you greater choice in where you go for treatment.
- Unlike Medicare Advantage Plans, these plans do not incorporate prescription drug coverage, so you should be sure to consider whether a standalone Part D plan or other supplemental coverages could be right for you.
You cannot have both coverages, so if you want to protect yourself from the out-of-pocket expenses that Original Medicare does not cover, you will need to choose which plan type is right for you.
Q: How do I know whether Medicare Advantage or a Medicare Supplement is right for me?
This depends highly on your situation. There are many factors to consider, include the cost and coverage level of the various plan types, which prescription drugs you take, and whether you travel frequently or live in more than one place during the year.
There is no need to try to make it through the Medicare maze all on your own. Our licensed agents have made it their mission to know the details of each product so they can help guide you through this important decision. Call us today at 1-888-970-2940 and let us help you find peace of mind that you have the right coverage for you.
Q: Can I get a Medicare Advantage plan or a Medicare Supplement if I do not have both parts of Original Medicare (Part A AND Part B)?
No. In order to get Medicare Advantage or a Medicare Supplement, you need to have already enrolled in Medicare Part A and Part B.
Q: When should I enroll in Medicare Part B?
That will depend on several factors. If you have employer sponsored healthcare, are actively working and your employer group has more than 20 employees, the group plan will be primary. In this case you will be able to delay enrolling in Part B until your situation changes. You will want to make sure that you sign up for Part B in a timely manner if you are retiring or losing your group coverage to avoid Late Enrollment Penalties.
If you do not have employer sponsored healthcare or your employer group has less than 20 employees you will want to enroll in Part B upon aging into Medicare.
Q: How do I sign up for Original Medicare?
Some people are enrolled in Medicare Part A automatically before turning 65.
- If you were not automatically enrolled in Part A, you can sign up for both Part A and Part B online at https://www.ssa.gov/benefits/medicare.
- If you were automatically enrolled into Part A, you can enroll in Part B by filling out this form (in English or Spanish which you then mail or take with you to your local social security office.