Medicare 101 – Start at the Beginning!

Medicare is health insurance that provides coverage for Hospitalization and Medical services through a government run program. Medicare is health insurance for people who are age 65 or older, individuals who have been entitled to Social Security disability for at least 24 months and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

Eligibility: Medicare eligibility begins at age 65. Medicare Part A covers Hospitalization other care in facilities. Medicare Part A is free for most individuals who have worked for 10 years (40 quarters) and paid taxes during that time. If you have not worked the required 10 years, you can purchase Medicare Part A coverage.  The actual cost to purchase depends on how many quarters you have worked. [CLICK to see Medicare Part A Costs]

Medicare Part B covers Medical treatment from physicians, outpatient services, lab test, kidney dialysis and medication for certain treatments such as chemotherapy and other injectable medication that must be administered by a physician. The cost of Medicare Part B is $174.70 monthly in 2024. [CLICK to see Medicare Part B Costs]

Medicare Part D covers Prescription Drugs. This coverage is available through private insurance companies. You must pay a monthly premium and cost varies by the plan chosen and may be adjusted for by your annual income. [CLICK to see Medicare Part D Costs]

Part A – Hospital Insurance
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care

Part B – Medical Insurance
• Services from doctors and other health care providers
• Outpatient care
• Cancer therapy
• Kidney dialysis
• Home health care
• Durable medical equipment
• Many preventive services

Part D – Prescription Drug Coverage
• Helps cover the cost of prescription drugs (including shots and vaccines)
• Run by private insurance companies that follow rules set by Medicare

Medicare Coverage Options

Original Medicare
Includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Participants may use any doctor or hospital that accepts Medicare anywhere in the U.S.

Medicare does not provide Drug coverage but sets rules that private companies must follow when offering Drug plans. Medicare requires that you have a drug plan.

Medicare Supplement, aka Medigap Plan
A Medicare Supplement, aka Medigap policy, is an insurance policy that helps supplement Original Medicare and is sold by private insurance companies. Medicare Supplements can help pay some of the health care costs that Original Medicare does not pay for, like copayments, coinsurance, and deductibles. All Medicare Supplement policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Each Medicare Supplement must offer the same basic benefits, no matter which insurance company sells it, Cost is usually the only difference between Medicare Supplement policies with the same letter sold by different insurance companies. If you have Original Medicare (Part A & Part B) and a Medicare Supplement, Medicare will pay its share of the Medicare approved amounts for covered health care costs, then your Medicare Supplement policy pays its share. Some Medicare Supplements also offer coverage for services that Medicare does not cover, like medical care when you are traveling outside the United States. Medicare Supplements have a monthly premium in addition to the Medicare Part B premium.
[CLICK Here to see Medicare Supplement Plans]

Medicare Advantage, aka Medicare Part C
Medicare Advantage plans, aka Medicare Part C and sometimes referred to as Medicare Complete, are private health plans offered through insurance companies that contract with Medicare to manage your healthcare. Medicare Advantage plans (MA and MAPD) are alternatives to Original Medicare that provide coverage of Part A, Part B, and usually Part D coverage (MAPD). Medicare Advantage Plans can be HMO, PPO or PFFS Plans. These plans typically help limit out-of-pocket costs and may include extra benefits that Original Medicare does not cover like dental, vision, hearing and fitness programs. Medicare Advantage plans may charge a premium in addition to the Medicare Part B premium. Many of these plans have a $0 monthly premium.
[CLICK Here to see Medicare Advantage Plan Types]