The Big Picture on Medicare
Original Medicare includes Hospital (Parts A and B) insurance. A separate drug plan (Part D) is optional. You can also add Medicare Supplement Insurance (Medigap) to help pay your out-of-pocket costs.
Part A Hospitalization
Medicare Part A is for everyone. In general, part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
Coinsurance of 20% applies and coverage has limits for hospitalization longer than 60 days at a time. If your work history qualifies, there are no monthly payments for Part A.
Part B Outpatient
Enrolling in Medicare Part B right away prevents penalty costs later, unless you’re covered by other medical insurance when you turn 65. Part B covers:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Medicare Supplement Plans (Medigap)
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. It’s preferred by people who want predictable healthcare costs, no matter how much healthcare they need. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay most of the remaining healthcare costs – depending on the plan you select. These remaining costs can consist of:
Part C Medicare Advantage Plans
Part D (Prescriptions)
…and more” Extra coverage included in many Medicare Advantage plans, but additional options in Medicare Supplement (Medigap) plans.
Long Term Care
If you’re receiving Social Security benefits, you’re likely already enrolled in Original Medicare, but may still have gaps in your coverage. If you’re a new ActivAger (turning 65 soon and planning an active retirement) you may need specific coverage options that cover your active retirement lifestyle.
Use our MediClear helper to zero in on the type of Medicare plan that provides the best coverage for your individual situation
At any time during your Medicare enrollment journey, call us at 941-567-6000 TTY 711 to ask questions and learn more. By contacting the phone number listed, you can expect to be in contact with a licensed insurance agent.
WE WILL NOT SHARE YOUR INFORMATION WITH ANYONE ELSE. By providing your information – such as name, phone number, and email address – you agree to allow an ActivAge licensed Insurance Agent to contact you about various health plans, services, and/or educational information related to health care.
Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program. Our National Producer Number is: 18595829
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Medical Terms and Definitions
- ReferralA written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don't get a referral first, the plan may not pay for the services.
- Rehabilitation servicesHealth care services that help you keep, get back, or improve skills and functioning for daily living that you've lost or have been impaired because you were sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
- Religious nonmedical health care institutionA facility that provides nonmedical health care items and services to people who need hospital or skilled nursing facility care, but for whom that care would be inconsistent with their religious beliefs.
- Respite careTemporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient's caregiver can rest or take some time off.
- Secondary payerThe insurance policy, plan, or program that pays second on a claim for medical care. This could be Medicare, Medicaid, or other insurance depending on the situation.
- Service areaA geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it's also generally the area where you can get routine (non-emergency) services. The plan may disenroll you if you move out of the plan's service area.
- Skilled nursing careCare like intravenous injections that can only be given by a registered nurse or doctor.
- Skilled nursing facility (SNF)A nursing facility with the staff and equipment to give skilled nursing care and, in most cases, skilled rehabilitative services and other related health services.
- Skilled nursing facility (SNF) careSkilled nursing care and rehabilitation services provided on a daily basis, in a skilled nursing facility (SNF). Examples of SNF care include physical therapy or intravenous injections that can only be given by a registered nurse or doctor.
- State Health Insurance Assistance Program (SHIP)A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.