What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).


The A,B,C and D’s of Medicare...

Medicare is divided into 4 parts, each covering a specific service:
Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

How Medicare works?

Medicare is a government program that has a wide variety of choices to servicing health care needs. There are a number of different health care coverages within the program and you can choose the way medical services are delivered, such as the Traditional way or a private health plan.


Traditional Medicare (Part A and B)

When a Medicare service is used, the patient pays a share of the bill and Medicare pays the remainder directly to the provider. The patient can go to any provider in the United States that accepts Medicare patients.

Medicare Advantage (Part C)

This option allows a person to choose a Health Care provider to provide the Part A and Part B of their health care services. Each year Medicare gives each Medicare Advantage plan a set amount of money for the care of each person enrolled with the plan. Each Medicare Advantage plan must provide at least the same services as a Traditional Medicare plan, however some plans offer additional benefits. The cost and benefits of a Medicare Advantage plan will vary. For some it may be less expensive than a Traditional plan or may offer additional benefits worth the consideration.


Prescription Drug Coverage (Part D)

Part D drug coverage works through private plans, in two ways (which type you can select depends on how you receive your medical benefits)....

  1. You can choose a “stand-alone” plan that covers only prescription drugs.

This option is available if you are enrolled in Traditional Medicare A, Medicare medical savings account, or a private fee-for-service plan that does not cover drugs.

  1. You can choose a Medicare Advantage private health plan that combines medical benefits and prescription drug coverage in one package.

This option is available if you choose a Medicare private health plan (HMO, PPO, PFFS or SNP) that combines medical care and prescription drug coverage in its benefit package.

What is Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Traditional Medicare doesn't cover, like copayments, coinsurance, and deductibles.
Many Medigap policies offer coverage for services that Traditional Medicare does not cover. So in addition to helping pay costs that Traditional Medicare does not cover, a Medigap policy may pay for other items such as health care outside the U.S.

Medigap Vs. Medicare Advantage

A Medigap policy is a supplement that covers gaps in coverage on Traditional (Original) Medicare. Medigap does not provide Medicare benefits such as a Medicare Advantage Plan, it only supplements a Traditional (Original) Medicare plan.

Key Items to Know about Medicare Supplement Plan (Medigap)


  • You must have Medicare Part A and Part B

  • If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.

  • You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.

  • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

  • You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

  • Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

  • It's illegal for anyone to sell a Medigap policy to someone with a Medicare Medical Savings Account (MSA) Plan.


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