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
- Long-term care ombudsmanAn independent advocate (supporter) for nursing home and assisted living facility residents who works to solve problems of residents of nursing homes, assisted living facilities, or similar facilities. They may be able to provide information about home health agencies in their area.
- MedicaidA joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
- Medical underwritingThe process that an insurance company uses to decide, based on your medical history, whether to take your application for insurance, whether to add a waiting period for pre-existing conditions (if your state law allows it), and how much to charge you for that insurance.
- Medically necessaryHealth care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
- MedicareMedicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- Medicare Advantage Plan (Part C)A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding hospice. Medicare Advantage Plans include:
- Health Maintenance Organizations
- Preferred Provider Organizations
- Private Fee-for-Service Plans
- Special Needs Plans
- Medicare Medical Savings Account Plans
- Most Medicare services are covered through the plan
- Medicare services aren’t paid for by Original Medicare
- Most Medicare Advantage Plans offer prescription drug coverage.
- Medicare-approved amountIn Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.
- Medicare-certified providerA health care provider (like a home health agency, hospital, nursing home, or dialysis facility) that's been approved by Medicare. Providers are approved or "certified" by Medicare if they've passed an inspection conducted by a state government agency. Medicare only covers care given by providers who are certified.
- Medicare Cost PlanA type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services or urgently needed services).
- Medicare drug plan (Part D)Part D adds prescription drug coverage to:
- Original Medicare
- Some Medicare Cost Plans
- Some Medicare Private-Fee-for-Service Plans
- Medicare Medical Savings Account Plans