MEDICARE TYPES ~Lou Saledas

Original Medicare

• Original Medicare is a fee-for-service health plan that has two parts:
  • Part A (Hospital Insurance) – covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.
  • Part B (Medical Insurance) – covers doctor and other health care providers’ services and outpatient care, durable medical equipment, home health care, and some preventive services.
  • Also covers clinical research, ambulance services, durable medical equipment, mental health including inpatient/outpatient and partial hospitalization, and limited outpatient prescriptions drugs.
• After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

Medicare Advantage

• Also referred to as Medicare Part C.
• Plans are offered by private insurance companies contracted through Medicare
• Alternatives to “Original Medicare” Parts A and B.
• The HMO or PPO version of Medicare.
• Beneficiaries will stay within a provider’s network
• There are co-pays, deductibles and coinsurance to be met.
• Full coverage begins on the first day of your effective date
• Some plans may also provide partial supplemental coverage, vision, dental and Part D prescription drug coverage.
• Some Medicare Advantage plans offer low or $0 dollar monthly premiums

Medicare Supplemental

• Also referred to as a Medigap policy and are guaranteed renewable.
• Private insurance companies offer coverage
• There are no provider networks
• Providers accepting Medicare insurance will accept Medicare Supplemental.
• Pays all or some of the health care costs that Medicare Part A and Part B do not cover.
• Medicare Parts A and B will typically cover 80% of most health care expenses.
• Medicare Supplement policies will cover 20% of all or some of the remaining health care expenses.
• These costs include co-payments, coinsurance, and deductibles.
• All Medicare Supplemental policies are standardized across all 50-states
• Premium amounts will vary across each insurer.
• Some policies may offer health coverage for your travels outside the United States.

Medicare Prescription Drug Plan

• Also known as Medicare Part D benefit.
• Subsidizes the costs of prescription drugs and prescription drug insurance premiums.
• Offered by private health insurers across multiple states with various different plans.
• Open enrollment for Part D plans takes place between October 15th and December 7th.
• Part D plans may coordinate with pharmacy networks offering discounts on prescriptions.
• Mail order options are also available for additional convenience and savings. 

Hospital Indemnity Plans

• Hospital Confinement Indemnity Insurance plans are designed to help with:
  • Co-payments
  • Deductibles
  • Out-of-pocket expenses
• Cash benefits are paid directly to you
• Covering the costs associated with:
  • Hospital confinement
  • Ambulance trips
  • Skilled nursing stays

This information is not a complete description of benefits.