Talk with a licensed Insurance Agent at 941-567-6000 (TTY 711)

Talk with a licensed Medicare Advisor
941-567-6000 TTY 711

Medicare At-A-Glance

The Big Picture on Medicare

Original Medicare

(medicare.gov)i

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 i

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 i

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) i

(view Medicare Supplement comparison chart)

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:

  • Copayments
  • Coinsurance
  • Deductibles

Part C Medicare Advantage Plans i

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all-in-one” alternative to Original Medicare. They are often preferred by people who want the lowest price on Parts A, B, and D, but may carry substantial out of pocket costs if you need healthcare. They are offered by private companies approved by Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

Part D (Prescriptions) i

Part D may be included in a Medicare Advantage Plan, but not in a Medicare Supplement plan or Original Medicare. All Medicare Part D plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

Extra Coverage i

…and more” Extra coverage included in many Medicare Advantage plans, but additional options in Medicare Supplement (Medigap) plans.

Dental

Hearing

Vision

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.

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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

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  • Certified (certification)
    See "Medicare-certified provider."
  • CHAMPVA
    A health care benefit for dependents of qualifying veterans.
  • Claim
    A request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered.
  • Clinical breast exam
    An exam by your doctor or other health care provider to check for breast cancer by feeling and looking at your breasts. This exam isn't the same as a mammogram and is usually done in the doctor's office during your Pap test and pelvic exam.
  • Coinsurance
    An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
  • Comprehensive outpatient rehabilitation facility
    A facility that provides a variety of services on an outpatient basis, including physicians' services, physical therapy, social or psychological services, and rehabilitation.
  • Copayment
    An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription drug.
  • Coverage determination (Part D)
    The first decision made by your Medicare drug plan (not the pharmacy) about your drug benefits, including:
    • Whether a particular drug is covered
    • Whether you have met all the requirements for getting a requested drug
    • How much you’re required to pay for a drug
    • Whether to make an exception to a plan rule when you request it
    • The drug plan must give you a prompt decision (72 hours for standard requests, 24 hours for expedited requests).  If you disagree with the plan’s coverage determination, the next step is an appeal.
  • Coverage gap
    A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the “donut hole”) starts when you and your plan have paid a set dollar amount for prescription drugs during that year.
  • Creditable coverage
    Previous health insurance coverage that can be used to shorten a pre-existing condition waiting period under a Medigap policy.