DCMIA - Medicare 101

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Medicare is the federal health insurance program, and it was created in 1965. This program was created to cover older Americans (those 65 years or older.) In addition, some folks with medical conditions or disabilities can get coverage from Medicare.

Most people will join Medicare when they turn 65 years old. In order to be eligible, most Americans will have to have worked for a minimum of 10 years. If you still have employer coverage when you turn 65, you will likely enroll in Medicare when you retire.

Original Medicare

Original Medicare consist of Medicare Parts A & B only. It covers 80% of all costs. The member covers the other 20%.

Original Medicare has deductibles and does not include a Rx plan or other benefits such as dental, hearing, vision, transportation, etc...

Medicare Part A - Hospital

Part A covers mostly any time you would spend at the hospital. This includes inpatient care, skilled nursing, as well as needs required in a nursing home or for home health care needs.

Part A does not cover long term care, like longer periods of time in a nursing home. A good option is to purchase long-term care insurance in case you think you will use a nursing home down the road.

For most people, you will not have to pay a premium for Part A (you already paid into it during your time in the workforce.)

It is important to know that Part A is not totally free however. Medicare will charge a deductible any time you need to be admitted into a hospital. Supplemental insurance can help cover this.

If you have any questions regarding how to enroll in Part A, or what is covered, we are happy to help you!

Medicare Part B - Medical

Part B of Medicare will cover your doctor visits, tests and screenings, any medicare equipment you need, ambulances, and other services.

This can include cancer treatments (radiation/chemo), imaging, and dialysis.

Included also in Part B are things like flu shots, mammograms, colonoscopies, and more.

You should know, Part B will generally cost more than Part A. For some, it may be an idea to delay signing up for Part B. We can help you do this, and avoid any penalties.

If you already are taking Social Security benefits at age 65, you will be automatically enrolled. Otherwise, you will need to enroll at age 65. It is important to apply for coverage before you will need it to ensure you don't have a gap in your insurance.

Medicare Part C - Advantage Plans aka MAPD

Medicare Part C is an alternative to traditional Medicare, and you should know they are optional. A Part C Medicare plan is a private Medicare plan - one that pays instead of normal Medicare.

What you get with a Part C (Medicare Advantage, or MA) plan, is coverage that includes Parts A, B, and likely D into one plan.

You will still enroll in Part A and Part B, as well as Part C. MA Plans sometimes pay for things not included in original Medicare, like dental and vision.

For these plans, you will likely choose and HMO or PPO. With an HMO, you will choose a primary care provider. With a PPO, you will have a network of doctors and facilities to choose from.

Medicare Part D - Rx

Part D of Medicare will pay some of your retail Rx drug costs. These plans have premiums, out-of-pocket costs, and copays. Some plans also have an annual deductible.

It is important to choose the right plan depending on what prescription drugs you are taking regularly.

Part D differs to Part A and B in that you will not enroll through Social Security. To enroll in Part D, you will choose from private insurance plans offered in your county.

Please note, these plans are optional, and there are rules for when you can enroll (and dis-enroll) from Part D.

Prescription Drup Plans (PDP)

Medicare Part D drug plans are sold by private insurance companies and are available to everyone on Medicare. They help to pay for prescription medications, helping to keep your out-of-pocket costs down while ensuring they get the drugs they need.

Since prescription coverage doesn’t come with original Medicare or most Medicare Supplement plans, Part D coverage is a must for most Medicare-eligible people.

There are two options for Medicare enrollment. Those who have original Medicare and medicare supplement insurance plans can enroll in standalone Part D plans. Enrollees can also get prescription drug coverage by enrolling in a Medicare Advantage plan.

Supplement Plans aka Medigap

Also known as Medigap, Medicare Supplement plans help to pay for your Medicare expenses. Things Supplements pay for include deductibles, co-pays as well as co-insurance.

Since Medicare only covers 80% of Part B expenses, many folks choose to add Medicare Supplemental Insurance in order to cover the 20% that isn’t covered by Medicare.

Some advantages of a Medicare Supplement policy are things like choosing your own doctors or hospitals, nationwide coverage, and no referrals are required before you can see a specialist.

Why Choose a Supplement Plan aka Medi-gap?

Some people are surprised to find out that their Medicare coverage only covers up to 80% of their Part B costs. Part B costs are things like doctor’s visits, ambulance transport, and other outpatient services. So it is easy to see how these costs can add up quickly. The 20% you have to pay can very easily be a very large number, and one that most people don’t budget for.

People that don’t want to be on the hook for this 20% can choose supplemental insurance to cover them in case they have to pay this extra amount. For many people, this extra peace of mind is worth it.

We offer options multiple Medicare options for your personal health and lifestyle.