Medicare

Life & Health

Medicare Plan: Part A-D

In general, individuals are eligible for Medicare if they (or their spouse) worked for at least 10 years in Medicare-covered employment and are at least 65 years old and are a citizen or permanent resident of the United States of America.

Individuals who are under 65 years old can also be eligible if they are disabled or have end stage renal disease. People under 65 and disabled must be receiving disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months before Medicare automatic enrollment occurs.

PART A — HOSPITAL INSURANCE

Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met.

PART B — MEDICAL INSURANCE

Part B medical insurance helps pay for some medical services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.

Furthermore, Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation,

PART C — ADVANTAGE PLAN

Part C, namely Medicare Advantage Plans, is health plan options that are part of the Medicare program. If you join one of these plans, you generally receive all your Medicare-covered health care through that plan. This coverage can include Medicare Part D prescription drug coverage or you can enroll in a separate Medicare Part D prescription drug coverage plan. Medicare Advantage Plans include:

Medicare Health Maintenance Organization (HMOs)
Referred Provider Organizations (PPO)
Private Fee-for-Service (PFFS) Plans
Medicare Special Needs Plans (SNP)
Medicare Medical Savings Accounts (MSA)

PART D — PRESCRIPTION PLAN

Part D, also known as Prescription Plans, provides eligibility to everyone with Part A or B. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, an individual with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD).

These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are able to choose not to cover some drugs at all.

Medigap

(MEDICARE SUPPLEMENTAL PLAN)

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the original Medicare Plan doesn’t cover.

If you are in the original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.

Medicare Plan: Part A-D

PART A — HOSPITAL INSURANCE

Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met.

PART B — MEDICAL INSURANCE

PART C — ADVANTAGE PLAN

PART D — PRESCRIPTION PLAN

Medigap

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