WHAT IS MEDICARE?
Medicare often referred to as Original Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Medicare Part A (Hospital Insurance)
Part A is the portion of insurance that covers your hospital care, skilled nursing facility care, some nursing home care, hospice and home health services. Cost sharing for Medicare Part A is an annual deductible and coinsurance. Depending on the service and length of stay you may have either a deductible and/or coinsurance or both.
Medicare Part B (Medical Insurance)
Part B is the portion of insurance that covers your medical care. Medical care includes: doctor office visits; Durable Medical Equipment (DME); mental health; observation stays; getting a second opinion before surgery; and some outpatient prescription drugs.
Medicare Part B has an annual deductible (deductibles may change from year-to-year). After you pay your annual deductible Medicare will pay the first 80% of all Medicare approved services. You are then responsible for the remaining 20% and any excess charges if they exist. Preventive care is generally covered at 100% by Medicare Part B.
Medicare Part C
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage plans (Part C) are bundled or all-in-one plans offered by a private company that contracts with Medicare to provide you with all of your Part A, Part B and with most plans Part D. Since Medicare contracts with private companies, Medicare requires all plans to offer, at minimum, the same benefits as Original Medicare.
Most Medicare Advantage plans have a network of providers. Some will allow you to go out-of-network for a higher cost. Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS). If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for under Original Medicare. This means that your claims are submitted directly to the insurance company and not to Medicare. These plans may also have lower out-of-pocket costs than Original Medicare.
You still have Medicare but get most of your Part A & Part B benefits from a private insurance company instead of the federal government. Medicare pays these plans to manage your care and covers almost all the costs of Medicare approved services.
Your costs on an MA plan are typically lower than Original Medicare. Medicare Advantage Plans typically have low monthly premiums – many as low as $0, but you must continue to pay your Part B premium. Most Advantage Plans often have no medical deductibles and cost sharing consisting of coinsurance and copayments. For example, a typical visit to see a primary care physician is as low as a $0 copayment depending on the plan. CMS requires all advantage plans to have a Maximum out of Pocket limit. These plans often include additional benefits like routine dental, vision and hearing and may also include wellness services including gym membership, telephonic and virtual nurse support, meals or transportation.
All plans cover you for emergency worldwide and urgently needed medical care everywhere in the U.S. and its territories. And as of JAN 1, 2021, all Medicare Advantage plans must cover people who have ESRD (End-Stage Renal Disease). NOTE: A Medicare Advantage plan is NOT a Medicare Supplement.
Medicare Part D
Medicare Part D (Prescription Drug Coverage)
Part D is an optional program offered by Medicare through private companies to help cover the high costs of your medications. If you are on Medicare Part A and/or Part B you are entitled to Part D overage regardless of health, income or medications.
If you choose to have this coverage you will pay a monthly premium. But if you do not take the coverage and delay signing up you may incur a late enrollment penalty that adds to the monthly premium.
Medicare Supplement (Medigap) Plans
Medicare supplement (Medigap) insurance plans are sold by private companies. Medigap plans often cover the out-of-pocket expenses associated with Medicare. These expenses include coinsurance, copayments and/or deductibles.
These plans are called Supplements or Medigap plans because they supplement, or fill in the gaps of your Original Medicare. Depending on the plan selected you can have all or some of these out-of-pocket expenses covered. Medigap insurance plans will have a premium and do not include Prescription Drug Coverage.
Medigap policies do not require you stay in a network of hospitals and doctors. You may see any doctor that accepts Medicare with no referrals from a Primary Care Physician. Unlike a Medicare Advantage Plan, Medicare pays its share of the Medicare-approved amount for covered health care costs first. Your Medigap plan will then pay its portion minus any agreed cost-sharing such as deductibles or copayments.
Medigap plans may also offer additional coverages not covered by Original Medicare.
Medicare Plans are available in your area.
Joski Insurance Agency has many plan options available from a variety of carriers. We have Medicare Advantage Plans (Part C), Prescription Drug Plans (Part D) and Medicare Supplements (Medigap Plans).
If you are looking for a Medicare Health plan or just have general questions, please call Steve to get your free, no obligation, review and quote. You can call (920) 468-4141 or email [email protected] to discuss your options. My goal is to educate you so you understand Medicare and set you up in a plan that suites your needs.
Our carriers include:
Wisconsin Physicians Services (WPS)