Medicare Explained

If you are nearing eligibility, it may be helpful to have Medicare explained.

Here is what Original Medicare (Parts A and B) is for as well as a few Medicare insurance plans that you may find necessary to add.

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Original Medicare explained

Original Medicare is Part A and Part B.

Part A is Medicare’s inpatient care coverage. 

It covers: 

  • Care you receive when you’re admitted to the hospital as an inpatient after an official doctor’s order
  • Skilled nursing facility care 
  • Hospice care
  • Home health care

Part B is Medicare’s medical insurance. It covers: 

  • Medically necessary services or supplies needed to diagnose or treat your medical condition
  • Health care to prevent illness or detect it at an early stage

Medicare Advantage

Medicare Advantage is an insurance plan that takes over for your Part A and B coverage while providing additional benefits.

Each plan has an out-of-pocket max (something Medicare doesn’t have) and can include: 

  • Adult day-care services
  • Dental
  • Vision
  • Hearing
  • Fitness club memberships
  • Prescription drug coverage
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits

What benefits you are offered will depend on where you live.

Medicare Supplements

Medicare Supplements take care of your cost-sharing responsibilities associated with Original Medicare. 

If you were to stick with Original Medicare, you are responsible for 20% of lots of services and care. 

Also, if you have a lengthy (or repeat) hospital stay you could become responsible for part of and, eventually, all of your inpatient costs.

There are 10 lettered Medicare Supplement plans which each cover a different percentage of: 

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • Part B coinsurance or copayment
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible*
  • Part B excess charge  
  • Foreign travel exchange (up to plan limits)

*As of January 1, 2020, Medigap plans sold to new Medicare beneficiaries aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare starting on January 1, 2020.

Medicare Part D

Original Medicare does not offer any assistance in paying for your prescription medications.

That’s where Part D steps in.

You can get Part D as a standalone plan or through a Medicare Advantage plan.