What is Medicare?

 Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital) and Part B (Medical). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles). 

 Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services. 

Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Also called Medicare Part C, these plans combine the benefits of Original Medicare (Part A and Part B) into a single plan with additional coverage, like dental, vision, hearing, wellness, and more. 

 Medicare Supplement, or Medigap, bridges the coverage gap left by Original Medicare (Part A and Part B) and covers costs like deductibles, copayments, and coinsurance.  

 Medicare Part D Prescription Drug Plans (PDP) work in tandem with Original Medicare (Part A and Part B) and Medicare Advantage plans to provide prescription drug coverage. 

 Dental and vision plans are additional ancillary products beneficiaries can purchase (as standalone or part of Medicare Advantage) since they are not included in Original Medicare (Part A and Part B) coverage. 

 With most HMO-based Medicare Advantage plans, enrollees generally receive covered healthcare services from medical providers who are members of the plan's network, except in emergency situations. Additionally, many HMO plans require an enrollee to obtain a referral from their designated primary care physician prior to receiving specialty or hospital-based care. These types of HMO-based Medicare Advantage plans are offered in select areas. 

MEDICARE ADVANTAGE PLANS (Part C)

Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans. 

Medicare Advantage Plans must offer at least the same benefits as Original Medicare (those covered under Parts A and B) but do so with different rules, costs, and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package. Plans set a limit on what you’ll have to pay out-of-pocket each year for covered services.

 A Medicare Advantage plan that provides targeted and specialized healthcare to specific patient populations, such as individuals who are dually eligible for both Medicare and Medicaid benefits, reside in nursing homes, or live with particular chronic medical conditions. 

A type of Medigap policy that may require the policyholder to utilize in-network hospitals and, if applicable, in-network physicians in order to qualify for full insurance benefits.

 State-administered programs that provide financial assistance to individuals with limited means, enabling them to offset some or all Medicare premiums, deductibles, and coinsurance. 

 The Program of All-Inclusive Care for the Elderly (PACE) is a special health plan that provides comprehensive medical and social services covered by both Medicare and Medicaid. In addition to these standard benefits, PACE also offers further medically necessary care and services as determined by an interdisciplinary healthcare team based on the individual's specific needs. By combining medical, prescription drug, social support, and long-term care services, PACE aims to serve enrollees who remain in the community. 

A state program that receives federal funding to provide free local health insurance counseling services to Medicare beneficiaries.

 A state program that provides financial assistance for prescription drug coverage eligibility based on financial need, age, or medical condition.