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Medicare Insurance

Understanding Medicare Insurance


Medicare and Medicare Supplemental insurance plans constitute a complex web of coverage options and features that collectively can be very difficult to understand. It is important for all Medicare beneficiaries to have a least a foundational understanding of the coverage options that are available. In other words, Let me help you navigate the complex web of coverage options.


Medicare has 4 separate and distinct parts that each cover specific items. Understanding each of these parts is important to know what coverage is best for you.


Medicare Hospitals and Doctors


Medicare Part A covers expenses that are incurred during hospital visits such as non-elective surgeries, medical tests, skilled nursing and other hospital related procedures. Medicare Part B covers standard health related issues such as checkups and regular doctor visits, durable medical equipment, and preventative services. Both Medicare Parts A and B can be supplemented to reduce your out of pocket expense. This is known as Medigap insurance. Medigap coverage does not cover long term care, vision and dental care.


Medicare Part D Prescription Drug


The Social Services Administration coordinates sign-ups, but is run by Medicare-approved private insurance companies. It helps cover the cost of outpatient prescription drugs. Medicare Part D Prescription Drug coverage is “voluntary”, however; to avoid a penalty for each month that you do not have Part D coverage, I recommend that you purchase a plan during your initial enrollment period.



Medicare Advantage


Medicare Part C is the combination of Parts A and B into a single plan and can also include Part D as well. Medicare Advantage offers four different types of plans that are common for people who are approaching retirement age. The HMO plan allows patients to choose a primary care physician within the network.  PPO plans aloe for any doctor to be chosen as long as they are part of the nationwide network of doctors.  PFFS plans allow patients to choose any doctor, provided that doctor agrees to the Medicare payment schedule. SNP plans are for individuals with specific conditions of diseases. Determining your eligibility and what plan is right for you is dependent upon your budget and overall health, as well as the county where you reside.


How do I qualify for Medicare?


Medicare is for people the age of 65, or for people under the age of 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD).



Where do I start?


Call me! I am a professional that can assist you in choosing the coverage that is right for you! Don’t take chances with your health coverage. All companies are represented as well as a variety of options to accommodate your individual needs.


The Standardized Medicare Supplement Plans (A through N)




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Medigap Benefits Medigap Plans
A B C D F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Part B deductible No No Yes No Yes No No No No No
Part B excess charges No No No No Yes Yes No No No No
Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A  $4,940



* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,180 in 2015 before your Medigap plan pays anything.


** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.


*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.


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