What is Medicare
What is Medicare?
Original Medicare
Medicare Part A (Hospital Insurance)
Part A helps cover inpatient hospital care (including critical access hospitals), skilled nursing facility care (excluding custodial or long-term care), certain home health services, hospice care, and inpatient care in religious nonmedical health care institutions.
Medicare Part B (Medical Insurance)
Part B helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, mental health services, limited outpatient prescription drugs, and various other medical services. It also includes coverage for many preventive services.
Medicare Advantage (Part C)
Medicare Advantage plans, also known as Part C, are private insurance plans approved by Medicare that provide an alternative to Original Medicare. These bundled plans typically include Part A and Part B coverage, and often include Part D prescription drug coverage. Many plans also offer additional benefits not available under Original Medicare, such as:
- Dental
- Vision
- Hearing
- Over-the-counter allowances
- Transportation to medical appointments
- Fitness programs
Advantages: Comprehensive coverage in one plan, often with low or $0 premiums, extra benefits, and the ability to switch plans annually during the open enrollment period. These plans can also coordinate with Medicaid.
Disadvantages: Potential Network restrictions unless you are on a PPO plan. May need referrals if you are on a HMO plan. Some services may require prior authorization.
Medicare Supplement (Medigap)
A Medicare Supplement plan (Medigap) is private insurance that helps cover the “gaps” in Original Medicare, such as deductibles, coinsurance, and copayments. These standardized plans (labeled A through N) allow you to see any doctor or provider who accepts Medicare, with no network restrictions. They do not cover prescription drugs (those require a separate Part D plan) and do not include extra benefits like dental or vision.
Advantages:
- Lower out-of-pocket costs
- No network restrictions
- Predictable expenses
- Guaranteed renewable
- Insurer cannot deny coverage for Medicare-approved medically necessary services
- For individuals with Veteran Benefits there may be ways to save money on the Part B premium cost.
Disadvantages:
- Cannot be used with Medicare Advantage plans
- Typically do not cover long-term care, dental, vision, or hearing
Medigap plans are especially helpful for individuals concerned about high out-of-pocket medical costs.
Medicare Part D (Prescription Drug Coverage)
Medicare Part D is an optional prescription drug plan offered by private insurers. It helps cover the cost of both brand-name and generic medications. You can enroll in a stand-alone Part D plan (if you have Original Medicare) or receive drug coverage through a Medicare Advantage plan that includes it.
Key Tips:
- Compare plans based on your specific medications, estimated total drug costs, and monthly premiums to find the lowest overall cost.
- Part D works well alongside Low-Income Subsidy (LIS) and Medicaid programs.
- Even if you currently take no medications, enrolling is recommended to avoid future penalties.
- Late Enrollment Penalty: If you go 63 or more days without creditable prescription drug coverage after becoming Medicare-eligible, you’ll face a permanent monthly premium surcharge (approximately 1% of the national base beneficiary premium per month of delay in 2026).
Cancer Insurance Policy
A cancer insurance policy is a supplemental insurance product designed to help manage the high out-of-pocket costs associated with cancer treatment. Upon diagnosis, it pays a cash lump-sum benefit directly to the policyholder, which can be used for deductibles, copays, transportation, household expenses, or any other needs. These policies are available to people of all ages and are often recommended for policyholders, their families, and friends as an added layer of financial protection.