Medicare Solutions
Getting Started with Medicare
Understanding Medicare can be a lot like trying to complete a puzzle, without the full picture it can be challenging to put the pieces together.
Original Medicare is comprised of Part A and Part B. Depending on your personal situation, you may be automatically enrolled in Medicare Part A and Part B, or you may need to apply.
Eligibility
65 and SSI
65 not taking SSI
Full disability for >2 years
Original Medicare
Medicare Supplements and Advantage
Medicare Part A
(Hospital)
Helps cover:
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Inpatient care in hospitals
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Skilled Nursing Facility Care
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Hospice Care
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Home Health Care
Medicare Part B
(Medical)
Helps cover:
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Services from doctors and other health care providers
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Outpatient care
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Home health care
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Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
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Many preventative services
Medicare Advantage
(Part C)
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare-approved plans offered by private companies which must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
Medicare Part D
(Prescription Drugs)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Plans that offer Medicare drug coverage (Part D) are run by private insurance companies that follow rules set by Medicare.
If you do not have a Medicare Part D plan, you may incur a penalty.
Medicare Supplements
(Medigap)
Because Medicare Part A and Part B doesn't cover everything, Medicare Supplements, (commonly called Medigap plans) are available to "fill in the gaps".
About
Each year, it’s important to review your Medicare health and drug coverage to make sure it still meets your needs, and decide if you want to make a change. You don’t need to sign up for Medicare each year, but you should still review your options.
*Medicare and You 2024, CMS.
Medicare Supplement (Medigap)
Plans offering a supplemental policy to fill “gaps” in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Medicare.
Medicare Advantage Plans
A Medicare Advantage Plan provides all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug coverage. There are generally two network types for Medicare Advantage Plans: Helath Maintenance Organization (HMO) or Preferred Provider Organization (PPO).
With an HMO network you can only get care from doctors or hospitals in the plan's network.
With a PPO netowrk, you still have in network doctors and hospitals, but you can also receive care outside of network, usually at a higher cost.
Medicare advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These "bundled" plans include Part A, Part B, and usually Part D. Some plan may offer additional benefits that Original Medicare doesn't cover - like certain vision, hearing, and dental services.