Medicare 101
The options for Medicare plans and program offerings can be overwhelming. I'm here to help!
Types of Medicare Coverage
Medicare is the federal health insurance program for:
People who are 65+
Certain people with disabilities
People with End-Stage Renal Disease (ESRD)
Original Medicare
Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital) and Part B (Medical). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
Medicare Part A (Hospital)
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services.
Medicare Part B (Medical)
Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Supplement, or Medigap, bridges the coverage gap left by Original Medicare (Part A and Part B) and covers costs like deductibles, copayments, and coinsurance.
Medicare Part C (Medicare Advantage)
Also called Medicare Part C, these plans combine the benefits of Original Medicare (Part A and Part B) into a single plan with additional coverage, like dental, vision, hearing, wellness, and more.
Medicare Part D (Drug Coverage)
Medicare Part D Prescription Drug Plans (PDP) work in tandem with Original Medicare (Part A and Part B) and Medicare Advantage plans to provide prescription drug coverage.
Medicare Dental & Vision Plans
Dental and vision plans are additional ancillary products beneficiaries can purchase (as standalone or part of Medicare Advantage) since they are not included in Original Medicare (Part A and Part B) coverage.
Medicare Health Maintenance Organization (HMO) Plan
With most HMO-based Medicare Advantage plans, enrollees generally receive covered healthcare services from medical providers who are members of the plan's network, except in emergency situations. Additionally, many HMO plans require an enrollee to obtain a referral from their designated primary care physician prior to receiving specialty or hospital-based care. These types of HMO-based Medicare Advantage plans are offered in select areas.
Medicare Preferred Provider Organization (PPO) Plan
Some areas of the United States offer a Medicare Advantage plan where members pay lower costs when utilizing healthcare services from physicians, facilities, and providers within the plan's covered network. While out-of-network care is also available, members would be subject to additional expenses when receiving care outside of the preferred network.
Medicare Savings Program
State-administered programs that provide financial assistance to individuals with limited means, enabling them to offset some or all Medicare premiums, deductibles, and coinsurance.
Medicare Special Needs Plan (SNP)
A Medicare Advantage plan that provides targeted and specialized healthcare to specific patient populations, such as individuals who are dually eligible for both Medicare and Medicaid benefits, reside in nursing homes, or live with particular chronic medical conditions.
Senior Health Insurance Benefits Advisors
A state program that receives federal funding to provide free local health insurance counseling services to Medicare beneficiaries.
State Pharmaceutical Assistance Program (SPAP)
A state program that provides financial assistance for prescription drug coverage eligibility based on financial need, age, or medical condition.
