What is Original Medicare?
Original Medicare includes Medicare Part A and Part B, which you sign up for through the Social Security Administration. Here’s a concise overview of Original Medicare:
Medicare Part A: Hospital Insurance
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, lab tests, surgery, and some home health care.
For most people, there is no monthly premium for Part A.
Medicare Part B: Medical Insurance
Medicare Part B covers certain doctors, services, outpatient care, medical supplies, and preventive services.
There is a base monthly premium for Part B which is set each year by CMS (Centers for Medicare & Medicaid Services). Higher monthly premiums are set for higher income-earners.
What Medicare Solutions Do We Offer?
At Creative Insurance Solutions, we provide a variety of Medicare solutions designed to meet the healthcare needs of seniors and eligible individuals. Here’s a concise overview of our offerings to fill in the gaps in Original Medicare:
Medicare Advantage (Part C)
Medicare Advantage, Part C, is a bundled plan offered by private insurance companies that includes all Part A and Part B benefits, and usually Part D. Options include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and more.
Part C monthly premiums can vary from $0.00 to a small dollar amount, depending on the plan selected. A few plans charge no premium and offer a refund (called a “give-back”) toward a portion of your monthly Part B premium.
Medicare Prescription Drug Plan (Part D)
The Medicare Prescription Drug Plan (Part D) adds drug coverage to Original Medicare and some other Medicare plans. Essential for managing prescription medication costs and is a requirement for Medicare beneficiaries unless they have prescription drug coverage through an employer or the Veterans Administration.
There is typically a monthly premium for Part D plans, but a few are available at $0.00.
Medicare Supplements (Medigap)
Helps pay some or most of the healthcare costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles, depending on the plan type you choose. Provides additional financial protection and peace of mind. Medicare Supplements have a monthly premium. However, plans are standardized into letter labeled plan types, so a Plan G is the same from any carrier. You can choose a less expensive carrier’s Plan G without giving up benefits.
These Medicare solutions offer comprehensive coverage options to ensure you have access to the necessary healthcare services and support. For more details, feel free to contact us or visit our website.
What Does Medicare Part A & B Cover?
Medicare Part A and Medicare Part B provide essential health coverage for seniors and eligible individuals:
Medicare Part A: Hospital Insurance
Inpatient Hospital Stays
Covers room, meals, and general nursing services.
Skilled Nursing Facility Care
Includes short-term care following a hospital stay.
Hospice Care
For terminally ill patients, including support services and certain medications.
Home Health Care
Limited to medically necessary part-time or intermittent skilled nursing care and therapy services.
Lab Tests and Surgery
Essential diagnostic and surgical procedures.
Medicare Part B: Medical Insurance
Doctor’s Services
Includes visits to primary care physicians and specialists.
Outpatient Care
Covers services that don’t require hospital admission, such as consultations and minor procedures.
Preventive Services
Screenings, vaccinations, and preventive check-ups to maintain health and detect issues early.
Medical Supplies
Durable medical equipment like wheelchairs and oxygen supplies.
In summary, Medicare Parts A and B collectively cover provide benefits for a wide range of
necessary medical services, ensuring comprehensive healthcare access for seniors and eligible individuals, but without additional coverage can result in significant out-of-pocket costs for services.
How Can Medicare Advantage (Part C) Benefit You?
Medicare Advantage (Part C) offers numerous benefits that can enhance your healthcare experience:
Comprehensive Coverage
Medicare Advantage combines Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan. Many plans also include Part D (prescription drug coverage).
Additional Benefits
Part C often covers services not included in Original Medicare, such as vision, hearing, dental, and wellness programs.
Cost Savings
Medicare Advantage plans may lower out-of-pocket costs compared to Original Medicare. Many plans have a yearly out-of-pocket maximum, providing financial protection.
Convenience
Medicare Advantage simplifies your healthcare with one plan, often including prescription drugs, and additional benefits.
Choice of Plan Options
Medicare Part C has several types of plans available, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Special Needs Plans (SNPs), allowing you to choose a plan that best fits your needs.
Coordinated Care
Many Medicare Advantage plans emphasize coordinated care, ensuring that your healthcare providers work together for the best outcomes.
Why Enroll in a Medicare Prescription Drug Plan (Part D)?
Enrolling in a Medicare Prescription Drug Plan (Part D) offers several key benefits:
Comprehensive Coverage
Medicare prescription drug plans help cover the cost of prescription medications, reducing out-of-pocket expenses for essential drugs.
Financial Protection
Medicare Part D plans provide predictable drug costs, protecting you from high medication expenses and aiding in budget management.
Access to Medications
Medicare prescription drug plans assist with covering the medications you need to manage chronic conditions, acute illnesses, and overall health maintenance.
Wide Plan Selection
A variety of plans are available to meet different needs and preferences, allowing you to choose one that covers your specific medications and fits your budget.
What Are Medicare Supplements (Medigap) and How Do They Work?
Medicare Supplements, also known as Medigap, are private insurance policies designed to cover costs not covered by Original Medicare (Part A and Part B), such as copayments, coinsurance, and deductibles. Here’s how they work:
What Are Medigap Policies?
Private Insurance
Medigap policies are sold by private companies to complement your Original Medicare coverage.
Standardized Plans
Medigap plans are standardized and labeled A through N, offering the same basic benefits regardless of the insurance provider.
How Do They Work?
Supplemental Coverage
After Original Medicare pays its share of covered healthcare costs, Medigap helps pay some or all remaining out-of-pocket expenses.
Nationwide Use
Medicare supplements are accepted by any healthcare provider that accepts Medicare, offering flexibility and ease of access.
Separate from Medicare Advantage
Medigap is different from Medicare Advantage (Part C) and cannot be used in conjunction with Medicare Advantage plans.
Do You Need Medicare Travel Coverage?
Medicare generally provides limited coverage for medical services outside the United States. Here’s why you might need Medicare travel coverage:
Limited International Coverage
Original Medicare
Medicare A and B typically do not cover healthcare outside the U.S. Exceptions are rare and generally limited to emergencies near the U.S. border or on a cruise ship within territorial waters.
Medicare Advantage Plans
With Medicare Advantage, coverage for international travel varies by plan, but most limit or exclude out-of-country medical services.
Peace of Mind
Travel insurance can provide access to necessary medical services and emergency assistance, ensuring you’re protected wherever you go.
You may not need Medicare Travel Coverage if your travel is limited to within the United States. If you travel internationally, however, it’s advisable to consider supplemental travel insurance to cover potential medical expenses not included in your Medicare plan. This extra protection provides the pace of mind that you can get the medical care you need when abroad and helps to minimize the expense of that care.
Navigating Medicare doesn’t have to be complicated. Contact Creative Insurance Solutions today for personalized guidance and help finding the Medicare coverage that best fits your healthcare needs and budget.
Explore Our Medicare Resources
Have questions about Medicare enrollment, costs, or coverage options? Visit our Medicare Resource Center for helpful guides, forms, checklists, and educational articles designed to help you make informed decisions about your Medicare coverage.
It’s not mandatory but we recommend enrolling when you are first eligible so that you don’t encounter late enrollment penalties. Enrolling in Medicare as a veteran can provide a useful and cost-effective supplement to your VA coverage. Medicare can cover gaps in VA coverage and provide access to care outside of the VA system in times of need. There is no cost for Part A hospital coverage for most people, but there is a monthly premium for Part B medical coverage. If you do enroll in Parts A and B, there are also Part C Medicare Advantage plans available at no cost to get access to even more coverage outside of the VA system.
You shouldn’t just let your plan renew without reviewing the changes to your benefits for the coming plan year. Your carrier will send you an Annual Notice of Change in the mail each fall highlighting any major changes that become effective January 1st. It is very important to also check to see if your prescriptions are still covered in the plan formulary as expected. The list of medications your plan covers may change so that your prescriptions may have higher out-of-pocket costs or could no longer be covered at all. Finally, be aware of the timeframe when you must make any necessary plan changes; the Medicare Annual Enrollment Period runs from October 15 to December 7 each year.
Original Medicare (Parts A and B) does not cover all your medical expenses so both Medicare Supplements and Medicare Advantage plans help fill in the gaps. A Medicare Supplement plan (sometimes called Medigap) is a separate plan with a monthly premium that serves alongside Original Medicare to cover what is left after it pays. Since you keep your Original Medicare, you can see any provider that accepts Medicare. Neither Original Medicare nor a Medicare Supplement include prescription drug coverage, so you will need a Part D plan as well. A Medicare Advantage plan replaces your Original Medicare, so you must use providers that are in the insurance company’s network. You can get a Medicare Advantage plan with no monthly premium, but you will pay copays for medical services as you use them. Medicare Advantage plans can include prescription drug coverage, and most offer some dental, vision, hearing, and other benefits as well that you don’t get with Original Medicare or a Medicare Supplement.
The Medicare Annual Enrollment Period (AEP) begins on October 15th and ends on December 7th. This is the broader enrollment period when all Medicare beneficiaries can make changes to their coverage. Changes made during this period will take effect on January 1st. The Medicare Advantage Open Enrollment Period (OEP) is a specific time frame for people already enrolled in a Medicare Advantage plan. A one-time switch can be made to a different Medicare Advantage plan, or you can drop a Medicare Advantage plan and return to Original Medicare (and possibly enroll in a Part D prescription drug plan). OEP runs from January 1st to March 31st each year and the change takes effect on the 1st of the following month.
Medicare Part A is hospital insurance. It covers a portion of inpatient hospital stays, care in skilled nursing facilities, hospice care, and may cover some home health care. Medicare Part B covers outpatient medical services, like doctor’s visits, outpatient tests and imaging, preventive services, durable medical equipment, and emergency ambulance services, among others. Parts A and B do not cover all costs; you will be responsible for deductibles, copays, and coinsurance (usually 20% of the approved cost), with no out-of-pocket maximum to cap your expenses.
The Initial Enrollment Period is the time frame to enroll in Medicare when you first become eligible due to turning 65. The IEP spans the 7-month period around your 65th birthday, including your birthday month and the 3 months before and 3 months after your birthday month
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