Your Trusted Medicare Advisor

Original Medicare is one of your health coverage choices as part of Medicare. You’ll have Original Medicare unless you choose a Medicare Advantage Plan or other type of Medicare health plan. You generally have to pay a portion of the cost for each service covered by Original Medicare.

• Medicare Part A and Part B cover certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. 
• Prescription drug coverage is provided through Medicare Part D.

• Inpatient care in a hospital 
• Inpatient care in a skilled nursing facility (not custodial or long-term care) • 
• Hospice care  
• Home health care 
• Inpatient care in a religious nonmedical health care institution

• medically necessary doctors’ services 
• outpatient care
• home health services
• durable medical equipment
• mental health services, and other medical services. 
• Covers many preventive services.

Under Original Medicare, if the Part B deductible ($185 in 2019) applies, you must pay all costs (up to the Medicare-approved amount) until you meet the yearly Part B deductible.  After your deductible is met, Medicare begins to pay its share and you typically pay 20% of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment. There’s no yearly limit for what you pay out-of-pocket.

• Medicare prescription drug coverage is an optional benefit. 
• Medicare drug coverage is offered to everyone with Medicare. 
• Even if you don’t use prescription drugs now, you should consider joining a Medicare drug plan. 
• If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Cosmetic surgery
• Massage therapy
• Routine physical exams
• Acupuncture
• Hearing aids and exams for fitting them
• Long-term care
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

Basic Medicare a.k.a. Original Medicare includes Parts A and B, which is going to pay 80 percent of your basic hospital and doctor expenses. Unfortunately, 20 percent of the expenses Medicare does not cover becomes the responsibility of the beneficiary.  A Medicare Supplement is a private plan designed to protect you from paying the 20 percent original Medicare will not cover. 

• You are currently covered under Medicare Parts A & B
• You are within 6 months of turning 65
• You are within 6 months of receiving Part B coverage
• If you are about to lose your group health insurance plan

• The Initial Enrollment Period. During your first 6 months of Part B coverage, your acceptance is guaranteed, regardless of your current level of health
• The "Guaranteed Issue" Period. If you are on the verge of losing coverage through an employer, you will have a "guaranteed issue" period lasting 63 days where you can purchase any Medicare supplement policy with no health questions asked.

If applying for a Medicare supplement outside of these time periods, you will need to qualify for a plan by going  through medical underwriting and answering a lot of health questions. 

Customers have questions, you have answers. Display the most frequently asked questions, so everybody benefits.

A Medicare Advantage Plan is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. 

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). 

In most cases, you’ll need to use health care providers who participate in the plan’s network. However, many plans offer out-of network coverage, but sometimes at a higher cost. 

Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

• You are currently covered under Medicare Parts A & B
• You are within 6 months of turning 65
• You are within 6 months of receiving Part B coverage
• If you are about to lose your group health insurance plan
• You live in the plan’s service area. 
• You don’t have End-Stage Renal Disease (ESRD). If you have End-Stage Renal Disease (ESRD), you can only join a Medicare Advantage Plan in certain situations.

• When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period.
• If you have Part A coverage and you get Part B for the first time during the General Enrollment Period, you can also join a Medicare Advantage Plan at that time.
• Between October 15–December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7.

Always review the materials your plan sends you (like the “Annual Notice of Change” and “Evidence of Coverage”), and make sure your plan will still meet your needs for the following year.

Customers have questions, you have answers. Display the most frequently asked questions, so everybody benefits.