MEDICARE 101
Medicare is health insurance for the following:
- People 65 or older
- People under 65 with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD)
Medicare Consists of 4 Parts:
| Medicare Plan | Type of Coverage | Plan Details |
|---|---|---|
| Medicare Part A | Hospital Insurance |
|
| Medicare Part B | Medical Insurance |
|
| Medicare Part C | Advantage Plan | Plans offered by private insurance companies that contract with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage plans may also cover other services, including prescription drugs. Medicare Advantage plans have different structures and may be HMOs, PPOs or Private Fee-for-Service plans (PFFS). If you are enrolled in a Medicare Advantage plan, Medicare services are covered through the plan, and Original Medicare will not pay for any healthcare services received by an enrollee in a Medicare Advantage plan. |
| Medicare Part D | Prescription Drug Coverage |
|
MEDIGAP Plan (Supplemental)
Medigap plans are supplemental insurance plans sold by private insurance companies to fill “gaps” in Original Medicare coverage. These plans are standardized across every carrier, meaning they must provide the same benefits. As of 2010, there are 11 available Medigap policies (A, B, C, D, F, high deductible F, G, K, L, M, and N). To qualify for enrollment in a Medigap policy, you must have Medicare Part A and Part B. Medigap policies only work in conjunction with the Original Medicare plan and will not pay for costs associated with Medicare Advantage. People in Medicare Advantage plans should not purchase Medigap policies. Below is a chart of the 11 available Medigap policies.
| Medigap Plan Coverage | Medicare first eligible before 2020 only | |||||||||
| Medigap Benefit | A | B | D | G | K | L | M | N | C | FA |
| Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B coinsurance or copayment | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100%B | 100% | 100% |
| Blood (first 3 pints) | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | 100% | 100% |
| Part A hospice care coinsurance or copayment | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | 100% | 100% |
| Skilled nursing facility care coinsurance | — | — | 100% | 100% | 50% | 75% | 100% | 100% | 100% | 100% |
| Medicare Part A deductible | — | 100% | 100% | 100% | 50% | 75% | 50% | 100% | 100% | 100% |
| Medicare Part B deductible | — | — | — | — | — | — | — | — | 100% | 100% |
| Medicare Part B excess charges | — | — | — | 100% | — | — | — | — | — | 100% |
| Foreign travel emergency (up to plan limits) | — | — | 100% | 100% | — | — | 100% | 100% | 100% | 100% |
| Out-of-Pocket Limit | ||||||||||
| $5880 | $2940 | |||||||||
A Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for medicare-covered costs up to the deductible amount of $2,300 in 2020 before your Medigap plan pays anything.
B Plan N pays %100 of the Part B coinsurance, except for copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
