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Medicare 101

How Medicare Works

Learning the Medicare lingo is the first step in understanding how Medicare works. There are lots of letters, plan names and new terms to understand.

We want you to feel like you have a good grasp on Medicare so you can choose a plan that’s right for you. This page will help you understand the common terms and how the different types of Medicare plans on the market compare to each other.

Defining Parts A, B, C and D

Medicare has four parts. Parts A and B are called Original Medicare. They’re run by the federal government. Medicare Part C is called Medicare Advantage. You buy Medicare Advantage plans from private health insurance companies that contract with the government. They work with Original Medicare coverage. Part D covers prescription drugs. Many Medicare Advantage plans combine Parts A, B and D in one plan. And each Medicare plan only covers one person.

Here’s an overview of some of the things each part covers. Each of these triangles represents a different part of Medicare. Part C shows a full triangle because it covers A, B and D on one card, with some extra benefits, too.

Defining parts of Original Medicare, Parts A, B, C and D plans

Part A Original Medicare

  • Hospital care
  • Skilled nursing facility care
  • Hospice
  • Home health care

Part B Original Medicare

  • Doctor visits
  • Mental health care
  • Outpatient surgery
  • Lab tests
  • Medical equipment like wheelchairs and walkers

Part Medicare Advantage

  • Everything parts A and B cover
  • Many plans cover prescription drugs
  • Many plans cover dental and vision

Part D Prescription

  • Prescription drugs

Original Medicare vs. Medicare Advantage

Medicare Advantage plans are popular because of their convenience. Most plans combine medical and prescription coverage on one card. Some offer dental and vision coverage, too. And you’re able to predict your out-of-pocket costs better than you can with Original Medicare.

When you have Original Medicare, you pay 20 percent of the cost, or 20 percent coinsurance, for most medical services covered under Part B. Medicare Advantage plans use copays more than coinsurance. Which means you pay a fixed cost. You might have a $15 copay for doctor office visits, for example.

And with Medicare Advantage plans, you have an out-of-pocket maximum. That means once you spend a certain amount of money on health care each year, your plan pays 100 percent of the cost of services it covers. Original Medicare doesn’t have this cap. So if you get really sick, you’ll end up paying a lot.

Supplement Plans vs. Medicare Advantage

Medicare supplement, or Medigap, plans are another option. In a way, Medicare Advantage replaces Original Medicare and connects all the pieces together on one plan. Supplement plans don’t replace Original Medicare. It’s more like an extra you can add on top of Original Medicare.

Blue Cross® Medicare Supplement and My Blue Medigap plans help pay some of the out-of-pocket costs you have with Original Medicare. For example, your plan might pay the 20 percent coinsurance for doctor office visits.

But if you go this route, you’ll need to make sure you have prescription drug coverage. That means that if you don’t have a Part D plan through an employer or union, you may face a penalty if you don’t buy one on your own. And supplement plans don’t come with the extra benefits you often get with Medicare Advantage, like dental and vision coverage.

The triangles to the right show how supplement plans sit on top of Medicare Parts A, B and D. You can get complete coverage, but you still have to coordinate all those pieces on your own. Medicare Advantage Part C gives you all the pieces with one cohesive plan.

Medicare Health Plans

Medicare has gone through a number of changes in the last few years and it can be hard to keep up with how policies evolve and how the market fluctuates. Some of these changes have been beneficial for all involved while others shift resources to areas that require individuals to make adjustments to secure their quality of life. PJ Insurance Agency is here to help make sure you can keep living the life you want.

If you are turning 65 years of age and looking for a Medicare plan, PJ Insurance Agency insurance experts provide access to the carriers you need in order to make an informed decision from every available Medicare option. We offer trustworthy guidance and solid expertise that seniors can benefit from when making one of the most important decisions regarding their healthcare coverage.

Staying Informed about Medicare Coverage

Learn the facts about the Medicare coverage options available to you from PJ Insurance Agency health insurance experts. Medicare coverage plans are standardized according to federal and state laws that also apply. Regulated Medicare coverage options are essentially the same with any plan, yet rates can vary significantly depending on the carrier you choose. Simplify your research and manage your costs with the Medicare insurance specialists who make your particular health concerns their top priority.

Committed to Protecting Seniors

PJ Insurance Agency has helped to fulfill the health insurance needs of countless seniors for many years. We are dedicated to finding the most suitable Medicare plans at the best possible rates for each client. Consult with our agents to discuss your concerns and learn more about the range of health plans including, Special Needs plans, PPOs, and HMOs that are tailored to meet your particular criteria for coverage.

Filling the Gaps in Your Coverage

If you are looking for Medicare supplement plans that fill the gaps with the coverage you need and allows you to benefit from services not covered by Medicare alone, contact a PJ Insurance Agency insurance agent to avoid confusion and provide clarity for your Medicare plan. Call us with any questions and to get started today.

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