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Local Medicare Insurance Agents in your area
Helping you find coverage for your individual needs!
Local Medicare Insurance Agents in your area
Helping you find coverage for your individual needs!
The Basics of Medicare
What is Medicare?
Medicare is the federal government program that provides health care coverage (health insurance) if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget.
Parts of Medicare
Part A covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits, and hospice care. Part A benefits are subject to a deductible ($1,484 per benefit period in 2022). Part A also requires coinsurance for extended inpatient hospital and SNF stays.
Part B covers physician visits, outpatient services, preventive services, and some home health visits. Many Part B benefits are subject to a deductible ($203 in 2022), and, typically, coinsurance of 20 percent. No coinsurance or deductible is charged for an annual wellness visit or for preventive services that are rated ‘A’ or ‘B’ by the U.S. Preventive Services Task Force, such as mammography or prostate cancer screenings.
Part C refers to the Medicare Advantage program, through which beneficiaries can enroll in a private health plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), and receive all Medicare-covered Part A and Part B benefits and typically also Part D benefits. Enrollment in Medicare Advantage plans has grown over time, with more than 20 million beneficiaries enrolled in Medicare Advantage Plans.
Part D covers outpatient prescription drugs through private plans that contract with Medicare, including stand-alone prescription drug plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs). The Part D benefit helps pay for enrollees’ drug costs and provides coverage for very high drug costs. Additional financial assistance is available for beneficiaries with low incomes and modest assets. Enrollees pay monthly premiums and cost sharing for prescriptions, with costs varying by plan. Enrollment in Part D is voluntary.
Medicare vs. Medicaid
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age. But there are special circumstances, like certain disabilities, that may allow younger people to get Medicare. Medicaid is a way to get health care at a lower cost or sometimes at no cost to you. Medicaid is managed by each state, so the eligibility requirements can change from state to state. Some people qualify for Medicare because of age (they’re age 65 or older) or due to having a disability. They’re also eligible for Medicaid because they meet the requirements to qualify for Medicaid in their state. These people are “dual eligible” because they’re eligible for both Medicaid and Medicare.
Plans We Offer
Medicare Advantage Plans
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Most plans also include "Part D" or prescription drug coverage. Additionally, our plans offer vison, hearing, and dental services plus gym membership with premiums as low as $0.
Medicare Supplement Plans
Medicare Supplement Insurance, sometimes called Medigap, is private insurance that helps fill "gaps" in Original Medicare. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance policy can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. Plans vary by coverage and cost. These plans do not include prescription drug coverage.
Prescription Drug Plans
Medicare Part D or prescription drug plans are also known as PDPs. These are standalone plans that can be purchased through private insurance companies. PDPs provide coverage for prescription drugs and medications and may also cover some vaccines too. Plans vary by location and provider in terms of costs and specific drugs covered. Each plan has a list of specific drugs it covers, known as a formulary, but all PDPs are required by law to cover certain common types of drugs.
Medicare Dual Eligible Plans
Some people have both Medicare and Medicaid. If so, they could be “dual eligible.” That’s where dual special needs plans — or “dual” plans — come in. Dual plans work together with the individual’s Medicaid plan. Dual health plans cover eligible doctor visits, hospital stays and prescription drugs. Dual plans go beyond either Medicaid or Original Medicare alone. And better yet, with a dual plan, you could get many extra benefits and features than Original Medicare at no extra cost. These extra benefits may include: dental care, plus credit for restorative work, eye exams, plus credit for eyewear, hearing exams, plus credit for hearing devices, rides to health care visits and the pharmacy, and credits to buy hundreds of health-related products. As an added bonus, people who are dual eligible can usually enroll for no monthly premium. That makes a dual plan a low-cost choice too.