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MEDICARE 101

Get to know the basics of Medicare! 

Medicare is a federal program that offers health insurance to American citizens and other eligible individuals. The program is often called Original Medicare. It has two parts—Part A and Part B.

Who is Eligible for Medicare?

Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

You must also meet one of the following requirements:

  • Age 65 or older

  • Younger than 65 with a qualifying disability

  • Any age with a diagnosis of end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).


What is Original Medicare?

  • Part A covers inpatient hospital and skilled nursing care.

  • Part B covers doctor visits and outpatient care.


WHAT DOES MEDICARE COST?

Medicare and many Medicare plans charge premiums—a fixed amount that you pay each month for your coverage.

You also pay a share of the cost for health care services you receive. There are three types of payments you may have:

  • Deductible: A set amount you pay out of pocket for covered services each year before Medicare or your plan begins to pay.

  • Copay: A fixed amount you pay at the time you receive a covered service. For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.

  • Coinsurance: A percentage of the cost for a covered service that you pay when you receive it. For example, Medicare might pay 80% of the covered service and the remaining 20% would be paid by you.


Private Medicare plans are optional and provide more coverage:

  • Medicare Advantage plans (Part C) combine Part A and Part B coverage. They often include drug coverage and other benefits you don’t get with Original Medicare.

  • Medicare prescription drug plans (Part D) help pay for medications. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.

  • Medicare supplement insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).


What are my Coverage Options with Original Medicare?

You can add coverage to Original Medicare or choose a Medicare Advantage plan instead. You have a few options when deciding what is best for you. 

Option 1: Original Medicare + Part D

Use your Original Medicare card + a Prescription Drug Plan (PDP) offered by a private insurance company

Option 2: Medicare Supplement (Medigap)

Use your Original Medicare card + a Medicare Supplement (Medigap) plan offered by a private insurance company + a Prescription Drug Plan (PDP) offered by a private insurance company

Option 3: Medicare Advantage

You may choose to get your benefits through a Medicare Advantage plan (Part C). Many plans come with built-in prescription drug coverage and may offer dental, vision, gym memberships, transportation and other benefits depending on where you live.

  • Part C with no drug coverage

  • Part C with built-in Part D prescription coverage

  • Available in HMO or PPO options (depending on where you live) 

Have Questions? Call to speak to a licensed agent at 1-800-343-1017