by adminCenia | Mar 7, 2025 | Education, Medicare, Medicare Advantage(Part C), Medicare Supplements
Medicare is divided into four main parts, each covering different aspects of healthcare. Here’s a breakdown of each:
- Medicare Part A (Hospital Insurance):
- Covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care.
- Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working.
- Medicare Part B (Medical Insurance):
- Covers outpatient services like doctor visits, outpatient hospital services, some preventive services (like screenings and vaccinations), and certain medical supplies.
- Part B requires a monthly premium.
- Medicare Part C (Medicare Advantage):
- An alternative to original Medicare (Parts A and B), offered by private insurance companies approved by Medicare.
- Includes all the coverage of Part A and Part B, and often includes additional benefits like prescription drug coverage, dental, vision, and hearing care.
- There may be extra costs for Part C, depending on the plan.
- Medicare Part D (Prescription Drug Coverage):
- Provides prescription drug coverage through private insurance plans.
- Part D requires a separate premium, and the plans vary in cost and coverage.
Medicare Part D (Prescription Drug Coverage) can be combined with options like a Medigap (Supplemental Insurance) to cover gaps in coverage from Parts A and B. We will go over Supplements in another post.
Does that help clarify things? Let us know how we can help you by filling out this contact form.
by adminCenia | Mar 7, 2025 | Education, Medicare, Medicare Supplements
Medicare Supplements, also known as Medigap plans, work alongside Original Medicare (Parts A and B) to help cover the out-of-pocket costs that Medicare doesn’t pay for. Here’s how it works:
Medicare Parts A & B Overview:
- Part A: Hospital insurance (covers inpatient stays, skilled nursing care, hospice, and home health services).
- Part B: Medical insurance (covers doctor visits, outpatient care, certain preventive services, and medical supplies).
What Medicare Supplements Cover:
Medicare Supplement plans are designed to fill in the “gaps” in coverage left by Original Medicare (Parts A and B). The gaps include:
- Coinsurance: The amount you pay for services after Medicare has paid its share.
- Copayments: Fixed costs for certain services or items.
- Deductibles: The amount you must pay before Medicare starts to pay.
Each Medigap plan (there are 10 standardized plans: A through N) offers different coverage levels. Some may cover things like:
- Part A coinsurance and hospital costs (after Medicare benefits are used up).
- Part B coinsurance or copayment (usually 20% of the cost of services).
- Blood (first 3 pints) for a transfusion.
- Skilled nursing facility coinsurance.
- Part A deductible and Part B deductible (depending on the plan).
- Emergency travel coverage (outside the U.S.).
How It Works:
- Original Medicare pays first: When you receive a Medicare-covered service, Medicare pays its share of the approved amount.
- Medigap pays second: After Medicare pays its part, the Medigap plan will cover some or all of the remaining costs, depending on the specific Medigap plan you have.
- You pay any remaining balance: If there’s any cost left that’s not covered by Medicare or your Medigap plan, you would be responsible for paying that amount.
For example, if you have a Medigap Plan G (one of the more comprehensive plans), it will cover:
- Part A coinsurance and hospital costs.
- Part B coinsurance (the 20% Medicare doesn’t cover).
- Part A deductible.
- Part B excess charges (if a provider doesn’t accept Medicare assignment).
You would still have to pay the monthly premium for the Medigap plan, and Medicare Part B also requires a premium, but Medigap reduces your overall out-of-pocket expenses.
Key Points:
- Medigap only works with Original Medicare (Parts A and B). It doesn’t work with Medicare Advantage (Part C) plans.
- Medigap plans are offered by private insurance companies.
- You need to enroll in Medicare Part A and Part B first before purchasing a Medigap plan.
Does that help clarify things? If you have a specific plan in mind or want to know more about how a particular Medicare Supplement(Medigap) plan works, feel free to fill out our contact form.
