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Original Medicare is composed of two parts: Part A and Part B (known as Original Medicare). A Medigap policy helps pay some of the health care costs that Original Medicare doesn’t cover like copayments, coinsurance and deductibles.  Part A is funded in full from the Medicare taxes you paid while working (or from the Medicare taxes a spouse paid).

 

Part A is Hospital Coverage. It helps cover the costs for:

  • Inpatient care in a hospital or skilled nursing facility (not custodial or long-term care).

  • Hospice and some home health care services.

  • While Part B is partially paid from taxes, it is supplemented with a Part B premium.

 

Part B is medical coverage that helps cover the costs for:

  • Doctor services, hospital outpatient care and some home health care services, as well as lab tests and durable medical equipment.

  • Most preventive services, including an annual wellness exam.

  • Medicare Part B enrollees with higher incomes could pay a higher Part B premium depending upon the extent their income from two years prior exceeds $85,000 ($170,000 for married couples). This is called the Income Related Monthly Adjustment Amount (IRMAA).

 

Upon turning 65, one must enroll in Medicare Part A, but Part B is optional. Some people may have other insurance coverage that will continue to be their primary coverage (e.g., certain company group plans or retiree plans). In these cases, it is not always necessary or prudent to enroll in Part B. Review your options carefully as there are penalties for not enrolling in Part B when you become eligible and are without other primary coverage.

 

Be sure your doctor accepts Medicare (also known as the Medicare Assignment). As long as your provider accepts Medicare, you will pay just the 20% coinsurance for the specified Part B services. If the provider agrees to see Medicare patients but doesn't accept the Medicare Assignment, they can charge up to 15% more than the Medicare reimbursement rate. If you choose to see this provider, you will be responsible for paying the 15% in addition to the 20% coinsurance amount. Medicare Supplements (also called MediGap) may cover some or all of these gaps.

Important Medicare Phone Numbers:

  1. For Medicare enrollment: contact Social Security at 1-800-772-1213

  2. For Medicare coverage questions: call 1-800-MEDICARE

  3. For government sponsored assistance with Medicare and Social Security contact HICAP (Health Insurance Counseling and Advocacy Program) at 1-800-434-02

 

Medicare

Medicare Part C  (Medicare Advantage)

 

  • Includes all benefits and services covered under Part A and Part B

  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan

  • May include extra benefits and services for an extra cost

  • This coverage is limited to certain geographical areas and carriers.

 

Medicare Part D (Medicare Prescription Drug Coverage)

 

  • Helps cover the cost of outpatient prescription drugs

  • Run by Medicare approved private insurance companies

  • May help lower your prescription drug costs and help protect against higher costs in the future.

 For More Information on Medicare or to Enroll Online