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
- Home health careHealth care services and supplies a doctor decides you may get in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered by your doctor.
- HospiceA special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver.
- Independent reviewerAn organization (sometimes called an Independent Review Entity or IRE) that has no connection to your Medicare health plan or Medicare Prescription Drug Plan. Medicare contracts with the IRE to review your case if you appeal your plan's payment or coverage decision or if your plan doesn't make a timely appeals decision.
- Inpatient rehabilitation facilityA hospital, or part of a hospital, that provides an intensive rehabilitation program to inpatients.
- Large group health planIn general, a group health plan that covers employees of either an employer or employee organization that has at least 100 employees.
- Lifetime reserve daysIn Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.
- Limiting chargeIn Original Medicare, the highest amount of money you can be charged for a covered service by doctors and other health care suppliers who don't accept assignment. The limiting charge is 15% over Medicare's approved amount. The limiting charge only applies to certain services and doesn't apply to supplies or equipment.
- Living willA written legal document, also called a "medical directive" or "advance directive." It shows what type of treatments you want or don’t want in case you can’t speak for yourself, like whether you want life support. Usually, this document only comes into effect if you’re unconscious.
- Long-term careServices that include medical and non-medical care provided to people who are unable to perform basic activities of daily living, like dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living, or in nursing homes. Individuals may need long-term supports and services at any age. Medicare and most health insurance plans don’t pay for long-term care.
- Long-term care hospitalAcute care hospitals that provide treatment for patients who stay, on average, more than 25 days. Most patients are transferred from an intensive or critical care unit. Services provided include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.