Welcome to Medicare 101

Understanding Medicare

The following is a brief description of Medicare and your options – just to get you started.

Original Medicare has two parts; A and B. Part A covers hospitalizations. Part B covers doctors, outpatient, etc.

Medicare has deductibles; You would pay a $1634 deductible for a hospital stay.

The Part B deductible is $185 plus 20% coinsurance. There is no maximum out of pocket on the 20% coinsurance – in other words you are responsible for the 20% until the

claim has been paid. A $50,000 bill means your are responsible for $10,000.

The question becomes, how do I cover my risk of having to pay the deductibles and coinsurance?

As the picture above illustrates, you have two main options; A Medicare Supplement or a Medicare Advantage Plan.

Medicare 101

Medicare Supplement

A Medicare Supplement will pay after Medicare pays.

Let’s say your $185 Part B deductible has been met. Your doctor visit is $100. Medicare will pay 80% ($80) and the supplement will pay the remaining 20% ($20).

Pros: You will be able to use any doctor or provider that accepts Medicare.

          Guaranteed Renewal.

Cons: Supplements that cover all of the Medicare deductibles can cost hundreds of dollars a month.

Medicare Advantage Plans

Medicare Advantage Plans replace original Medicare. They are private insurance companies that are funded by Medicare to handle all of your medical needs rather than Medicare.

With Advantage Plans, you will NOT show your Medicare card because Medicare is not the payer. Your Advantage Plan will pay all of the claims and you typically must stay in the Advantage Plans network or you will not have coverage (HMO) or have higher copays/coinsurance (PPO).

Pros: Low premiums. May have additional benefits beyond basic Medicare.

Cons: Must stay in network, may need authorizations from the doctor or plan before testing, may need referrals from a primary care doctor before seeing a specialist.

What are the main differences between my options?

Freedom of Provider Choice  (where you receive your care) and Monthly Premiums.

Medicare Supplements

Higher freedom of choice

Higher Premiums

Medicare Advantage Plans

Lower freedom of choice

Lower premiums

Choose Whats Best For You