Medicare 101
Understand the basics before choosing a direction.
1
Start With Original Medicare — Parts A & B
Part A — Hospital Insurance generally helps cover inpatient hospital care, skilled nursing facility care under certain conditions, hospice care and some home health care.
Part B — Medical Insurance generally helps cover physician services, outpatient care, preventive services, durable medical equipment and other medically necessary services.
Parts A and B form the foundation of Original Medicare, but they do not necessarily cover every healthcare cost.
2
Understand Your Two Main Medicare Directions
ORIGINAL MEDICARE
Parts A + B
Someone using Original Medicare may also consider:
Part D — Prescription Drug Coverage
Medicare Supplement (Medigap) — helps with certain out-of-pocket costs in Original Medicare.
OR
MEDICARE ADVANTAGE — PART C
Medicare Advantage plans are offered by Medicare-approved private insurance companies as another way to receive Medicare-covered Part A and Part B services. Many plans also include prescription drug coverage and may offer additional benefits. Networks, costs and plan rules can vary.
There isn't one Medicare direction that's right for everyone.
3
Consider Prescriptions, Costs & Timing
Prescription Coverage
Formularies, pharmacy networks and drug costs can vary. Your medications and preferred pharmacy matter.
Healthcare Costs
Look beyond the monthly premium. Depending on your coverage, costs may include premiums, deductibles, copayments and coinsurance.
Enrollment Timing
Turning 65, working beyond 65, retiring or losing employer coverage can affect when Medicare enrollment should occur.
Enrollment rules depend on your circumstances. Verify important dates and eligibility with Medicare or Social Security before making a coverage change.
4
Your Medicare Decision Roadmap
1. Where are you now?
Identify your current coverage and situation.
2. What is changing?
Retirement, turning 65, moving, plan changes, medications, providers or other circumstances.
3. What matters to you?
Doctors, hospitals, prescriptions, travel, healthcare usage and costs.
4. Understand your directions.
Original Medicare and its related coverage choices versus Medicare Advantage.
5. Make an informed decision.
You choose the direction. I'll help you understand the road ahead.
5
Review Your Direction & Official Resources
Healthcare needs, medications, providers, costs and plan details can change. Reviewing your coverage periodically can help you understand whether it still fits your situation.
A review does not automatically mean you should change coverage.
Official Resources
Medicare.gov | Social Security Administration | VA Health Benefits
Things People Often Learn Too Late
Networks can change. A doctor or hospital you use today may not remain in a plan's network.
Drug coverage varies. Drug lists (formularies), pharmacy networks and drug costs can differ by plan and change over time.
Timing matters. Missing certain Medicare enrollment periods can delay coverage or, in some circumstances, lead to late-enrollment penalties.
Before You Choose a Direction
Which doctors and hospitals matter to me?
What prescriptions do I take?
Do I travel or live in another state part of the year?
Am I comfortable with provider networks?
What could my total healthcare costs be, beyond the premium?
The lowest premium isn't necessarily the lowest overall cost.