What’s Original Medicare?

Original Medicare refers to Parts A and B and is managed by the federal government and provides Medicare eligible individuals with coverage for and access to doctors, hospitals, or other health care providers who accepts Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service.

Medicare is the federal health insurance program for:

• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What is Part A (Hospital Insurance)?

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Generally, if you’ve worked at least 10 years (40 quarters) and paid Medicare taxes while you worked, you’re eligible for premium-free Part A.

What is Part B (Medical Insurance)?

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

How Do I Get Parts A & B?

Some people get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. In most cases, it depends on whether you’re getting Social Security benefits.

What is Part C (Medicare Advantage)?

Medicare Advantage is a Medicare health plan that you can get from a private insurance company. This plan gives you all the benefits you get with traditional Medicare, and possibly more. Some Medicare Advantage plans include prescription medicine coverage (Part D). You may also get coverage for dental, hearing, vision, and wellness programs.

What is Part D (Prescription Drug Coverage)?

If you use Medicare, you can join a private health plan that pays for prescription drugs. This coverage is called Part D, or the Medicare prescription drug benefit. Each insurance company that offers a Part D plan decides which drugs it will cover and how much they will cost.

Is Medicare Part D Optional?

You’re not required to enroll into a Medicare Part D Prescription Drug Plan.

How much does Medicare cost?

Listed below are basic costs for people with Medicare.

Source:
Medicare.gov. (2021). 2021 costs at a glance [Table]. Medicare.gov The Official U.S. Government Site for Medicare. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

What Are the Medicare Plan Star Ratings and How Are They Measured?

Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest.

What Is a Medicare HMO? What Are the Differences Between HMOs and PPOs?

There are four main types of Medicare Advantage plans, but Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are the most common types. Here is a comparison of the two varieties:

• HMO plans require that beneficiaries see health-care providers, doctors, and hospitals within the plan’s network except in urgent and emergency situations. In some plans, known as HMO Point-of-Service (HMO-POS) plans, beneficiaries may be able to go out-of-network for certain services, but may have to pay a higher cost.
• PPO plans have in-network and out-of-network expenses. They do not require that beneficiaries use in-network providers and do not require a referral to see a specialist. Using out-of-network providers will cost more.
• HMO plans require that beneficiaries choose a primary care physician.
• Both HMO and PPO plans generally include prescription drug coverage through a Medicare Advantage Prescription Drug plan (MAPD).

What’s the Difference Between Medicare Advantage and Medicare Supplement Insurance?

There are different ways that you can receive your Medicare coverage, or add onto that coverage. Medicare Advantage and Medicare Supplement Insurance are options that may sound similar, but they’re quite different. They do have one main thing in common: they’re both offered by private insurance companies. The main difference is that Medicare Advantage contracts directly with Medicare and therefore are funded by Medicare, whereas Medicare Supplement Insurance do not contract with Medicare and only covers the gap what Medicare does not cover.

Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).

Medicare Supplement (Medigap) Insurance is optional insurance you can get from a private insurance company. Medigap plans pay some of your Original Medicare (Part A and Part B) costs, such as coinsurance and copayments.