Medicare Definitions

Medicare Definitions and Benefits

Medicare supplements or Medicare Advantage?  Are you confused or overwhelmed with all of the information you’re being inundated with now that you’re Medicare eligible? If so, take heart because you are not alone. The Medicare & You book is a great place to start, but it is not the most captivating read!

The easy definitions below will help you understand each part of the Medicare program and get you started toward choosing the option that is right for you!

Original Medicare

Original Medicare comes in a couple different parts, A & B, and covers most of your expenses, but not all.

Medicare Part A:

Medicare Part A helps cover inpatient hospital care such as room and board, nursing staff, skilled care, limited home health, hospice and inpatient medication. Medicare Part A is generally premium free.

Medicare Part B:

Medicare Part B covers the medical side including the doctors, outpatient procedures, durable medical equipment, lab work, etc. Medicare Part B has a monthly premium and there is an annual deductible. After that, Medicare will generally pay 80% of approved charges and you are left with the remaining 20%.

Medicare Part C:

Medicare Part C is also commonly referred to as Medicare Advantage.  See the full Medicare Advantage description at the bottom of this page.

Medicare Part D:

Medicare part D covers outpatient prescriptions. Private insurance companies contract annually with Medicare to provide you with drug coverage. A prescription drug plan (PDP) will have a premium, deductible and co-payments for covered medications; each plan will have their own formulary or list of covered drugs. Medications are organized into tiers, generally the lower the tier, the lower the co-pay. Learn more about Medicare part D here: Medicare Part D Overview

If you would like to learn more about covering the “gaps” in your Medicare coverage, simply contact us to set up an individual appointment or sign up for one of our Welcome to Medicare seminars.

Medicare Supplements

Medicare supplements, also known as Medigap plans, help cover some or all of the out-of-pocket expenses you are responsible for under Original Medicare. Medicare supplements are offered through private insurance companies and benefits are dictated by which plan letter you purchase.

There are ten Medicare Supplement Plans available, and no matter which company is offering it, they must provide the same benefits as any other company with that plan letter. For example, if company ABC is offering Plan G, your coverage will be the same as company XYZ’s Plan G. The difference will be in your premium.

Contact us now by calling, 812.473.7271 to discuss all of your options. We will take the time to explain your options so you can make informed decisions.

Medicare Advantage

A Medicare Advantage Plan, known as Part C, is another way you can get Medicare coverage. These are private insurance companies that contract with Medicare to provide benefits to you.You are still in Medicare and still pay your Part B premium, but Medicare is not paying your claims.

Medicare Advantage Plans have networks of doctors, hospitals and pharmacies. This type of plan is called managed care and can be in the form of a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or Private Fee For Service (PFFS). HMOs have the most restrictive care as they do not have out of network coverage. PPOs and PFFS plans have in and out of network coverage.

These plans often include drug coverage, lower monthly premiums with maximum out-of-pocket expenses that are met by your co-payments.

Free Medicare Advice:

Hopefully these definitions will help you understand the different parts of Medicare so you can make a more informed decision for your healthcare needs.  If you have Medicare questions or want to talk to one of our Medicare Specialists about a plan that is right for you, simply call us at 812-473-7271 to setup a free appointment today!