medicare

Medicare Options

What is “Original” Medicare?

Medicare provides basic, affordable health coverage for beneficiaries. You cannot be denied Medicare coverage due to pre-existing conditions and coverage cannot be cancelled if you get sick. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS).

You are eligible for Medicare if at least one of the following applies to you:

  • People 65 or older
  • People under 65 with certain disabilities
  • People of any age diagnosed with End-Stage Renal Disease (ESRD)
Eligible individuals are entitles to Original Medicare which includes Part A & Part B only.

Part A – Hospital Insurance

  • Helps pay for some of the costs of inpatient hospital care, critical care, skilled nursing facilities, hospice care and some home health care
  • There is no premium if you have worked a minimum of ten years in Medicare-covered employment and are eligible for Social Security Benefits
  • There are deductibles you must pay
  • Private health plans like Medicare Supplements and Medicare Advantage plans offer insurance to add to the basic Medicare coverage

Part B-Medical Insurance

  • Helps pay for some of the costs of doctors’ services, outpatient hospital care, physical and occupational therapy and home healthcare
  • There are deductibles you must pay and a monthly Part B premium
  • Your premium is deducted from your social security benefits
  • Private health plans like Medicare Supplements and Medicare Advantage plans offer insurance to add to the basic Medicare coverage

What is NOT covered by Original Medicare?

Contrary to popular misconception, Original Medicare does NOT cover ALL healthcare expenses and there is no maximum limit on the amount you might have to pay out-of-pocket.

Original Medicare does not cover the following costs:

  • Part A and B copayments, deductibles, and coinsurance
  • 20% of Part B medical services (with no annual or lifetime limit on your out-of-pocket costs)
  • In-patient hospital and skilled nursing care charges above Medicare limits
  • Most health care received outside of the United States
  • Services Medicare considers not medically necessary. Medicare may not consider certain tests, diagnoses, and frequent visits to be medically necessary and will not reimburse for any test that is judged to lack a medically necessary diagnosis or that does not adhere to frequency guidelines.
  • Eyewear, denture, and hearing aids
  • Routine dental services
Private insurance companies offer additional plans to help cover the costs that are NOT covered by Original Medicare.

Private Medicare Supplemental Insurance Plans

Part C- Medicare Advantage

Part C gives you the option to choose a Medicare Advantage (MA) plan in which you assign your Medicare Parts A and B benefits to a private health plan that administers your benefits on behalf of Medicare

Part D- Prescription Drug

Prescription Drug Plan (PDP) is a private health plan that offers prescription drug coverage under contract with Medicare. It helps pay the cost of your prescription drugs.

Medicare Supplements

Medicare Supplement Insurance (Medigap) policies are sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles.

*Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. (2012) Centers for Medicare & Medicaid Services.