Original Medicare
This is the primary medical insurance available to individuals 65 and over and the qualified disabled, to cover many of your healthcare services. Insured patients can visit any doctor or hospital that accepts Medicare. This gives you flexibility on where you get your medical care from. There are costs for care in the form of deductibles, copays, and coinsurance. Although Medicare in general is responsible for 80% of your medical costs, there are no limits to your 20% share of costs. And you are not required to have a Part D drug plan but you can be penalized for not having one.
These costs are referred to as gaps in Medicare coverage. It is these “gaps” that you may purchase additional Medicare insurance to cover.
Original Medicare is broken out into Parts A and B:
Medicare Part A covers hospital stays, emergency room visits, hospice, and limited amounts of inpatient rehabilitation services offered in skilled nursing facilities.
Medicare Part B covers outpatient treatments and services like preventative care, lab tests, mental health services, ambulance rides, outpatient operations, medical equipment, and most other medical services not performed in a hospital.
Medicare Part D drug plans unlike Medicare Parts A & B are offered exclusively by private insurers, not by Medicare. You will generally purchase a plan that is the most cost effective based on your specific medication needs.
Medicare Supplement or Medigap Coverage
Medicare Supplement plans cover some of the gaps and fees not covered by Original Medicare. This coverage kicks in for healthcare related costs remaining after Medicare approves and pays its share of the costs. The Medicare Supplement Insurance pays what is left, essentially covering “the gap” in coverage. As an independent Florida Medicare plan specialist, Cornerstone Insurance will assist in getting the specific Medicare supplement plan for your needs.
The best time to purchase a Medicare supplement policy is during the 6-month initial enrollment period beginning the month you turn 65, you’re enrolled in Medicare A & B and are guaranteed issue regardless of any health issues.
Medicare Advantage Or Medicare Part C
The Medicare Advantage program (Part C) gives people an alternative way of receiving their Medicare benefits through private insurance carriers.
These are called “Advantage” plans for a reason. With a Medicare Advantage Plan, there is no need to carry a Medicare supplement or Medigap policy as these plans must cover all the services of Original Medicare at a minimum. In addition most of these plans will include a prescription drug benefit along with additional non Medicare benefits such as dental, vision, hearing and fitness programs. However, you do have to visit doctors and hospitals within the plans provider network.
Types of Advantage plans:
- Health Maintenance Organizations (HMO),
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
Medicare Part D Also Known As The Medicare Prescription Drug Benefit
Although Medicare Part D was established by the federal government, unlike Original Medicare (Parts A and B) which is publicly administered, Medicare Part D is exclusively provided by private insurance carriers.
Medicare Part D covers the costs of self administered prescription drugs while drugs provided by a doctor as part of an operation or hospital stay are typically covered by Original Medicare.
Cornerstone Insurance tailors the Medicare experience to your personal needs, ensuring you get the best coverage available for your specific situation. Contact us today to discuss all of your needs and plan options.