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Medicare

Making sense of options to complete your coverage

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Original Medicare

  • Original Medicare includes Part A and Part B.

  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).

  • To help pay your out-of-pocket medical and prescriptions costs  (like your 20% coinsurance), you can also have coverage from a former employer or union, or Medicaid or buy supplemental coverage, like Medicare Supplement Insurance (Medigap), Part D drug coverage, Medicare Advantage as discussed below.

Part A (Hospital Insurance) Helps Cover:

  • Inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

You should enroll in part A at no cost upon turning 65

Part B (Medical Insurance) Helps Cover:

  • Services from doctors and other health care providers

  • Outpatient care

  • Home health care

  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

If you delay enrollment in part B coverage you must maintain an employer sponsored plan or comparable coverage to avoid being penalized.

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Two options to complete your coverage

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Option 1: Medicare Supplement + Part D

Medicare Supplemental Insurance (MEDIGAP):

Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.

Part D (Prescription coverage):

Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you obtain it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. You must maintain some form of drug coverage after turning 65 to avoid late penalties.

Option 2: Medicare Advantage (Part C)

  • Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

  • In most cases, you’ll need to use doctors who are in the plan’s network.

  • Plans may have lower out-of-pocket costs than Original Medicare.

  • Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

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What if I'm Medicaid Eligible?

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Dual Eligibility

If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

 

You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (Part C). If you have Medicare and full Medicaid, you’ll get your Part D prescription drugs through Medicare. And, you’ll automatically qualify for extra help paying for your Medicare Drug Coverage (Part D). Medicaid may still cover some drugs and other care that Medicare doesn’t cover.