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Table of Contents

What Is Medicare?

Once you turn 65 you’ll need to decide if you’re going to use Original Medicare (Parts A and B) and a Medicare Supplement Insurance Policy, Medicare Advantage plus a Medicare Supplement Insurance policy, or just get one or the other but not a include a Medicare Supplement Insurance policy.

Keep in mind, it’s highly unlikely that Original Medicare nor Medicare Advantage will cover all of your medical costs, so unless you have a Medicare Supplement Insurance policy, you could be stuck with big expenses that you’ll need to cover out of pocket.

When you qualify for Medicare, it’s usually Medicare Part A and Part B that you’re first enrolled in. Medicare Part A and Part B make up what’s commonly known as Original Medicare.

Medicare Part A generally helps pay your costs as a hospital patient.

Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more.

Medicare eligibility begins when you’re 65 years old. Technically you can initially apply for it when you’re within 3 months of turning 65, and then that application period extends to 3 months after you turn 65.  So, including the month you turn 65, there’s a 7 month initial application window. And yes, you do have to apply for it.  After you’re approved, most people typically qualify for what’s know as Original Medicare, or Medicare Part A and Medicare Part B.

Medicare Part A generally helps pay your hospital costs associated you’re a stay for care.

Medicare Part B generally helps pay for more non-emergent medical situations including doctors visits, preventive health services, certain lab tests, medical equipment and supplies needed for particular conditions, and possibly other things.

What Is Medicare part a?

Medicare Part A is known as hospital insurance. Part A generally covers inpatient hospital stays, certain home health care related services, skilled nursing care, and hospice care.  The way it works is Medicare Part A will pay most of the costs associated with the care, but you will typically have to pay a deductible, and a copayment or coinsurance.  The specific plan you get will indicate the details of how it all works.

Do you have to pay A part a premium?

The general answer to that is no.  Most people do not pay a monthly or yearly premium for Medicare Part A. But there are certain situations where you may have to. For example, if you worked at least ten years and were paying income taxes, then you won’t have to pay a premium for Medicare Part A. If you worked for fewer than 7.5 years, then as of 2021 you will general have to pay $471 per month in premium.  If you worked more than 7.5 years, but less than 10 years, then as of 2021 your premium is $259. So basically the way it works is whether you pay a premium or not, and how much you pay, are depending on how long you’ve been working and paying taxes.  We all fund Medicare through out taxes, so in a sense you get out of it what you pay into it.

What Is Medicare part b?

Medicare Part B is known as medical insurance that can be thought of similarly to what your ‘regular health insurance’ pays for while you’re working and under the age of 65.  The following are examples of items and services it covers:

  • Doctor’s visits
  • Flu shots
  • Pneumoccal shots
  • Other loan payments
  • Chemotherapy
  • Durable medical equipment, including wheelchairs & walkers
  • Diabetes screenings, supplies & therapy
  • Alcohol use counseling
  • Outpatient mental health care
  • Physical therapy

How much will you pay for Medicare part b?

In most cases you will pay 20% of the Medicare-approved amount for each item or service. A deductible may also apply. So again, it’s similar to how your private or regular health insurance works, whether it’s through Aetna, United HealthCare, or many of the other larger health insurance organizations.

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Gap in Coverage

The good news is there are many things that will be covered between Medicare Part A and Medicare Part B. However there will also be many things and portions of many things that will not be covered. For example, extended illness requiring extensive and varied health care may force you to go out out pocket and pay large bills that won’t be entirely covered. Additionally, if you are sick a lot and need to take more than routine or infrequent trips to the doctor, some of your costs may not be covered. So a way that most people look to safeguard themselves against having exorbitant bills is by getting a Medicare Supplement Insurance policy to “close the gap” between the total costs are and what Medicare Part A and/or Medicare Part B will cover.

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What Is Medigap?

Medigap is a term used to describe the “gap” between what Medicare will cover and what it will not cover. It is not an actual insurance policy. Medigap policies are used to pay bills for you, by covering out of pocket medical care costs you’d have to pay for on your own, which are not covered by Original Medicare. Medicare Supplement Insurance is a type of Medigap policy, and is used to either lessen the gap between your bills and what will be covered by Original Medicare, or it can close the gap entirely.

What Is Medicare supplement insurance?

A Medicare Supplement Insurance Policy is a form of Medigap.  There are other ways to close the gap, and purchasing a private Medicare Supplement Insurance policy is one way to do it.  But, really there’s nothing else more to it than just understand the terminology.

Why purchase Medicare supplement insurance?

Doctor Visits: How Medicare Supplement Insurance Plans can Help

Generally speaking, you’ll still need to pay a deductive and a copayment or coinsurance with Original Medicare, which means you’ll still likely have to pay some of your doctor’s visits and hospital visits out of pocket.  And the reality is these costs can be high and drain your savings, especially if you go to the doctor a lot.

So, one way to help offset these costs is by purchasing a Medicare Supplement Insurance policy. If you know that you will be visiting the doctor multiple times a month, the amount you could save on copayments by having a Medicare Supplement insurance plan could exceed the cost of the additional insurance plan and so it can be worth it to you to have a Medicare supplement policy.

It’s hard to forecast whether this will be financially beneficial for everyone, but odds are that it could be. You could always purchase a Medicare supplement insurance policy, see how your health goes for a few years and what your doctor’s visits look like, and then decide to cancel it.

Hospitalization: How Medicare Supplement Insurance Plans may Help

If you have to spend a long time in a hospital, then having a Medicare supplement policy could save you a lot of money. If you are using Medicare and are hospitalized for 1-60 days, you pay $0 coinsurance for each benefit period under Medicare Part A (your hospital coverage), but between days 61-90, you would pay $371 per day in 2021 that you’re in the hospital, and at day 91 and beyond you would pay $742 coinsurance in 2021 per each lifetime reserved for each benefit period, up to 60 days over your lifetime. After that you pay 100% of the hospital costs.  So the costs could really add up.

As an example, if you have a 70 day hospital stay, that would cost you $3,710 and a 95 day hospital stay would cost you $14,840, not counting the Medicare Part A deductible for 2021. If you had a Medicare Supplement policy this could save you thousands of dollars.  And this generally doesn’t include other services like specialists, tests, or procedures.   So the costs of extended hospital stays could be a fortune.

Durable Medical Equipment: How Medicare Supplement Insurance Plans may Help

Durable medical equipment is a fancy name for items including hospital beds wheelchairs, walkers, or other things needed to help provide care services. Things like this are typically covered under Medicare Part B and included as part of coinsurance. Similar to hospital stays and doctor’s visits, depending on the types of equipment needed and how long it may be needed (for example, a hospital bed that you may need to have in your home), the costs could be very high and will likely not be fully covered under Part B.

So, a Medicare Supplement Insurance plan could be a good way to help cover the gaps in cost. For example, a hospital bed that costs $2,000 might have a coinsurance amount of $400 (the Medicare Part B coinsurance is typically 20%). A Medicare Supplement insurance plan may pay for this coinsurance and save you the out of pocket costs.  Of course, different plans have different basic benefits, so our agents will help you figure out the right plan based on your situation

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Medicare will typically only cover 65% of your costs. It pays to explore how a Medicare Supplement policy can cover the rest.

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What Is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare (Parts A and B).  It is also known as Medicare Part C.  Unlike Medicare Part A and Part B, which are offered by the government, Medicare Advantage plans are private health insurance plans that you can buy from a company as long as they are approved by the federal government.  And Medicare actually pays your Medicare Advantage plan to cover your benefits.  Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can also include additional coverage as well.

Examples of additional coverage typically can include dental benefits, routine vision care, certain health or wellness programs, and prescription drugs. So, you might be able to get Medicare Advantage if you want it, and it might be better for you than Original Medicare, but it might not cover all of your needs so you should still research whether a Medicare Supplement Insurance plan can help you.

One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (know as Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan when you’re enrolled in Original Medicare. That helps make things a little easier. These Medicare Prescription Drug Plans are also known as a  Medicare Advantage Prescription Drug plans, and they help simply things by allowing you to have your Medicare Part A, Part B, and Part D coverage through a single plan.

If you want prescription drug benefits, you should considering getting it through a Medicare Advantage plan that includes this coverage; you shouldn’t enroll in a Medicare Prescription Drug Plan, which typically works with Original Medicare. Medicare Advantage plan costs and coverage details can vary depending on the insurance company and county that you live in.  Similar to Medicare, and Medicare Supplement, this is something we can help you determine.

Things To Consider

What to consider when making your choice:

There are several factors that can influence what type of health insurance program you should choose once you turn 65 and whether Medicare Supplement insurance is right for you.  You should consider your health condition, current financial situation, future financial outlook, and your lifestyle to help you make the right decisions.  We can walk you through a needs analysis as part of our free consultation.  But the bottom line is for some people, traditional Medicare plus Medigap can work, and for some people a Medicare Advantage-only program can work.  Here are some things to consider:

Costs

Long stays in the hospital and frequent doctor’s visits, including the need for specialists rises when we get older, and especially when we get into the 65+ age range.  Medical equipment costs for things like wheelchairs, walkers, canes, hospital beds, among other items aren’t cheap, and might come into play.  For example, a hospital bed that costs $2,000 might have a coinsurance amount of $400 (the Medicare Part B coinsurance is typically 20%). A Medicare Supplement insurance plan may pay for this coinsurance and save you the out of pocket costs.

Choosing Your Doctors

Original Medicare allows you to use any U.S. doctor or hospital that accepts Medicare, and most do. However, most Medicare Advantage plans restrict you to using physicians in their network and may cover less, or none, of the expenses of using out-of-network and out-of-town providers. So if you’re accustomed to using certain doctors under your insurance plan before you go on Medicare, then you might need to make a switch if you go with a Medicare Advantage plan.

Medicare Advantage managed care plans provide the ability to coordinate care between specialists and your primary care doctor so that can help simplify things. With traditional Medicare, you will need to coordinate communication between your primary doctor and your specialist and that will may also include prior authorization for procedures so more burden will be placed on you.

Local Conditions and Convenience

In some areas, access to health care including hospitals, emergency rooms, and doctors (especially specialists) may be challenging.   So, as you pick your healthcare plan you should look to see different networks of available Medicare Advantage plans and if there are any providers in the local area.  If not, then Medicare Advantage might not be right for you, and you might have more flexibility with Original Medicare and a Medicare Supplement Insurance plan.

Advice from local professionals, neighbors, and of course a licensed insurance broker like us can help you find the best plan solution for your needs.

Your Lifestyle Matters

If you travel a lot, have multiple residences, or see doctors that you want to keep seeing, then Original Medicare is likely to offer you more flexibility in terms of seeing the doctor you want and at the facility you want, when you need it.  You should ask your current doctors if they accept regular Medicare, and also see if they participate in any Medicare Advantage plans, and if so, which one’s.

Additionally, if you spend any significant time out of the country then you should consider a Medicare plus Medicare Supplement Insurance policy that offers emergency coverage in foreign countries. The same concept applies to people who live in different areas at different times, like folks who plan to spend their summers at a beach house, and winters in the mountains. For things like this Medicare Advantage is likely to be very limiting.

Health Considerations

Your health situation should be a major consideration when deciding if you select Medicare or Medicare Advantage.  If you have a chronic disease or health condition or think that given your health history or family health history you might develop one, then having a Medicare Insurance Policy will give you better coverage since neither Original Medicare nor Medicare Advantage will cover all of your costs.

One thing to consider is, some Medicare Advantage plans have an out of pocket maximum that could protect you from those big bills, so if you have or think you’ll have out of the ordinary health issues, then this could be something to look into. The same line of thinking applies to if you’re on or think you’ll be on multiple prescription drugs or need expensive medical equipment.

Broader Benefits

The government is continuing to work with Medicare Advantage plan providers to increase coverage beyond what regular Medicare covers.  Examples include benefits that cover paying for wheelchair ramps, service animal food, railings and bars in your bathroom, adult day care, and other items for the home, including air quality monitoring devices.

Learn everything about health insurance with Policy Solver. Find medicare insurance quotes, compare plans, and get covered. Contact us or schedule a free consultation today!

Key Takeaways:

  • Enrolling in Medicare Parts A and B isn’t enough; you might have tens or hundreds of thousands of dollars in out of pocket expenses if you have a hospital stay without a supplemental policy.
  • You should discuss a Medicare Supplement policy with a licensed representative.
  • You will typically have more flexibility in the choice of doctors you can see with a Medicare Supplement policy vs. A Medicare Advantage policy.
  • Your lifestyle choices should be evaluated when deciding what type of medicare supplement policy to get.

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Get All The Info Frequently Asked Questions

Original Medicare consists of Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). It’s a federal health insurance program for individuals 65 or older; under 65 who have a qualifying disability; and of any age with a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease).  

Original Medicare Part A is hospital coverage. It helps pay for hospital stays and inpatient care in hospitals.

Original Medicare Part B is medical coverage. It helps pay for doctor visits and outpatient care.

No. Medicare and Medicaid are both government programs that help people pay for health care, but they are not the same thing.

Medicare is a federal program that provides health care coverage for people who are 65 or older or have certain qualifying disabilities.

Medicaid is a joint state and federal program that provides health care coverage for individuals and families with limited incomes. “Dual eligibility” means you qualify for both Medicare and Medicaid.

No. Original Medicare doesn’t cover prescription drugs. Part A may cover some drugs you get as an inpatient. Otherwise, prescription drug coverage, also known as Medicare Part D, is available separately through private insurance companies approved by Medicare. You can get prescription drug coverage either through a stand-alone Part D plan (PDP) or a Medicare Advantage plan (MAPD) that includes prescription drug benefits.

Generally, no. Original Medicare doesn’t cover routine vision or dental care, eyeglasses, or hearing aids. Part B may cover some dental or vision services if you meet certain conditions and they are considered medically necessary, but you’ll have to check with your health care provider and Medicare first. Many Medicare Advantage (Part C) plans, however, do offer these benefits. Be sure to compare the benefits of all plan options to find the coverage that best fits your needs.

Original Medicare Part A pays for some skilled nursing services, but doesn’t cover long-term or custodial care (daily life activities like eating and bathing). You’d also still be responsible for a portion of the costs, such as deductibles, copays and coinsurance.

Medicare Advantage plans (Part C) can combine Parts A, B, and D in a single plan. All Medicare Advantage plans include:

  •  All the benefits and coverage of Medicare Part A
  • All the benefits and coverage of Medicare Part B

Plus, Medicare Advantage plans can include:

  • Prescription drug coverage (Part D)
  • Routine vision, dental, and hearing coverage
  • Fitness benefits and wellness programs 
  • And more

Medicare Advantage and Medicare Supplement plans are very different, and you can’t have both at the same time.

A Medicare Advantage (Part C) plan combines Part A, Part B, and often Part D (prescription drug) coverage into one plan. These plans may also include additional benefits, such as hearing, vision, dental, and fitness. Medicare Advantage plans also have an annual limit on out-of-pocket costs on covered services.

A Medicare Supplement (Medigap) plan helps with some of the out-of-pocket costs that Original Medicare doesn’t pay, like coinsurance and copayments.

Most Medicare Advantage (Part C) plans offer routine vision care, such as eye exams, eyeglasses, and corrective lenses. Original Medicare (Parts A and B) alone doesn’t cover routine vision care. 

Medicare Part D is prescription drug coverage. Medicare Part D plans (PDP) help pay for medications prescribed by a doctor. Part D plans are offered by private insurance companies approved by Medicare. The types of drugs covered is decided by the U.S. government. Beyond that list, every Medicare Part D plan covers a different set of drugs. When choosing a Part D plan, you need to make sure it covers the drugs you take.

Most Medicare Advantage (Part C) plans already include Part D prescription drug coverage, combined into a single plan with hospital and medical. Another option is to have a separate Part D plan in addition to Original Medicare, a Medicare Supplement Insurance plan, or a Private Fee-For-Service plan.

Medicare Supplement insurance plans, offered by private insurance companies, help pay some of the out-of-pocket costs that Original Medicare (which includes Part A and Part B) doesn’t pay. Medicare Supplement plans are also known as Medigap plans.

Your acceptance into a Medicare Supplement insurance plan is guaranteed if you apply during the Medicare Supplement Open Enrollment Period. It starts on the first day of the month in which you’re both age 65 or older AND enrolled in Medicare Part B. You can apply for a Medicare Supplement insurance plan any time during the year, and some states have additional enrollment periods and guaranteed enrollment situations.

If you apply outside of this timeframe or another guaranteed issue period, you may be denied coverage or charged more based on your health history. This doesn’t apply if you live in Connecticut and New York, where guaranteed issue is ongoing and Medicare Supplement plans are guaranteed available.

It depends on what your health situation is, what you forecast it to be, where you plan to live, and the doctors you will want to go to.  There are so many factors.  There are ten standardized Medicare Supplement insurance plans. All of them pay towards out-of-pocket costs for Medicare-approved services. Some plans pay most or all of your out-of-pocket costs, but have a higher monthly premium. Other plans pay fewer out-of-pocket costs, but have a lower monthly premium. Benefits and costs vary depending on the plan chosen. Plans C and F are only available to individuals who were eligible for Part A or who turned 65 before January 1, 2020.  We can figure all of this out for you when you connect with one of our licensed agents.

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Policy Solver Insurance Agency LLC is a licensed independent insurance broker in Virginia, selling Long Term Care, Life, Health, and Annuity products, under VA License #152124. Multiple other states licenses details available upon request. The information provided on this site is for public consumption to help educate and inform consumers, and we work to make sure it is as up to date as possible. In some cases there might be content that is in the process of being refreshed as part of our quality review process. Any insurance calculations, or quotes for policy information including premiums are considered non-binding, but to be used as a guide to help inform the educational process. We work with many different insurance carriers, who will ultimately, through underwriting, determine the final terms including costs of policies.

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