fasttrack

Medicare 101

How Does Medicare Work?

Medicare is challenging. We make it simple. There are a variety of plans in your area, but more than likely, only a handful of carriers and their plans will meet your health goals and financial needs. But first things first! Here is a quick overview of Medicare and its many moving parts. You should also remember that you cannot have a Medicare Advantage Plan and a Medigap plan at the same time, so you will have to decide which plan meets your financial goals and health needs. Contact us for assistance along the way!

Medicare Part A

Must enroll via the Social Security Administration
No monthly premium for most beneficiaries
Inpatient Hospital Care
Skilled Nursing Facility Care
Hospice Care
Home Health Services

Medicare Part B

Must enroll via Social Security Dept.
Most individuals will pay a monthly premium
Primary Care and Specialist visits
Lab Services
X-rays, CT Scans and MRI’s
Outpatient surgery
Emergency & Urgent Care
Durable Medical Equipment (Crutches, CPAP Machines, Oxygen Tanks, etc.)
Preventive Services: Annual physicals, well-woman exams, flu shots, colonoscopies, etc.

Medicare Part C

Offered by private insurance companies that contract with Medicare
Low and sometimes no monthly premium
Must enroll through a private insurance carrier
Network-based care
Maximum Out of Pockets
Some have Value Added Benefits Available (Dental, Vision, OTC drug allowance)
May be an HMO, which may require referrals and managed (network) care, but they can also be PPO’s offering out of network benefits.
Many have Part D drug plans included
Special Needs Plans available for people with Medicaid or chronic health conditions

Medicare Part D

Covers prescription medications
Must enroll through a private company that is contracted with Medicare or via enrollment in a Medicare Advantage Plan with Prescription Drug coverage (MAPD)
Plans will have different formularies which is the list of medications covered by a plan
Deductibles and copays will vary from plan to plan
Must be entitled to Part A and/ or enrolled Part B
Must live in a plan’s service area.