Medicare ABCs (and D)

Medicare Part A –Original Government Managed Plan

1. Covers Limited hospital coverage.
2. Policy holder does not pay premium
3. Policy holder is not required to pay deductibles
4. There are limits on how much hospitalization will be covered also known holes in the original Medicare.

Medicare Part B - Original Government Managed Plan

1. Covers Doctor visits and other non-hospital medical treatments and a few drugs
2. Policy holder pays a monthly premium
3. Policy holder pays annual deductible
4. Policy holder pay 20% co-insurance

Medicare Part C known as Advantage Plans - Privately Managed

1. Cover at least original Medicare A & B
2. Adds more coverage for hospitalization
3. Gives you more options for doctors depending on the plan
4. May save you money on doctors and specialists

Medicare Part D known as Drug Plans - Privately Managed

Helps you pay for medication and protects you in case of catastrophic drug costs

Filling in the Holes

Question: Medicare A and B are defined by most experts as good medical insurance, so why do you need anything else?
Answer: Original Medicare has limits on lengths of hospitalization, doctors you can use and does not include most drugs you need to buy.

Additional Advantage Plans Coverage Options

Medicare Advantage Plans

1. A non-government company will provide you with your Medicare insurance.
2. There are different types of Medicare C providers
   • Health Maintenance Organization plans (HMO)
   • Preferred Provider Organization plans (PPO)
   • Private Fee-For-Service plans (PFFS)
   • Special Needs Plans (SNP)
3. All plans cover Medicare A and B
4. Most plans cover Medicare D as well
5. All plans must be approved by the Medicare program
6. Some plans offer extras like free annual physical exams, vision care, gym memberships)
7. Most plans include prescription coverage

Medicare Supplement Plans also known as Medigap Plans

Medicare still handles your Medicare A and B but a non-government company will supplement it with a wider set of services.

1. Plans are standardized by Medicare
2. Premiums start at about $110 per month
3. Sold by insurance companies
4. Usually you can assume you will be compensated on medical services across the country.

Medicare Prescription Coverage (Part D)

1. Can be purchased as a standalone plan or included in a Medicare Advantage plan.
2. Different plans and co-pay levels give you different advantages
3. Plans may have deductibles
4. Plans may cover generics in the “doughnut gap
5. Beware of the Doughnut hole. All policies stop covering you once you it a certain spending level. The plan will only pick up once you pay out an additional sum on drugs.
6. There is a $250 government rebate if you reach the doughnut hole.