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Medicare Insurance

Looking for Medicare plans or ways to save money on Medicare? Find affordable Medicare plans that are in step with your life. Turning 65 and getting started with Medicare can be stressful. Affordable Medicare Solutions is here to help solve all of your Medicare problems. Call to speak with a licensed insurance agent.


What Is Medicare?

Medicare is the federal government’s health insurance program that primarily covers people 65 and older and certain younger people with disabilities or kidney failure. Original Medicare does not cover all medical costs. Medicare Advantage plans stand in the place of Original Medicare or you may opt to stay with Original Medicare and purchase a Medicare Supplement policy.


How does Medicare work?

Medicare is a government-funded health insurance program that provides medical coverage for people over the age of 65. You may be eligible for Medicare if you:

  • have a disability and have been receiving social security disability benefits for two years
  • have a disability pension from the Railroad Retirement Board
  • have Lou Gehrig’s disease (ALS)
  • have kidney failure (end-stage renal disease) and receive dialysis or have undergone a renal transplant

This health insurance can be used as primary insurance or as supplemental, backup coverage. Medicare can be used to help pay for medical care and long-term care, but it might not cover all your medical expenses.

It’s funded by taxes and, in some cases, premiums that are taken out of your social security checks or that you pay.

What are the parts of Medicare?

Medicare is designed to cover your essential medical needs, such as hospital stays and doctor visits. The program is composed of four parts: Part A, Part B, Part C, and Part D.

Part A and Part B are sometimes called original Medicare. These two parts provide for the majority of essential services.

Part A (hospitalization)

Medicare Part A covers your hospital care, including various hospital-related services. Most of your care related to treatment is covered by Part A if you have to go to the hospital as an inpatient. Part A also covers hospice care for those who are terminally ill.

For most people with a modest income, there will be no premiums. People with higher incomes may have to pay a small amount monthly for this plan.

Part B (medical)

Medicare Part B covers your general medical care and the outpatient care that you may need to stay healthy, including:

  • A large portion of preventative services
  • Medical supplies (known as durable medical equipment, or DME)
  • Many different types of tests and screenings
  • Mental health services

There is typically a premium for this type of Medicare coverage, based on your income.

Part C (Medicare Advantage)

Medicare Part C also known as Medicare Advantage, is not actually a separate medical benefit. It’s a provision that allows approved private insurance companies to provide insurance plans to people who are enrolled in Parts A and B.

These plans cover all the benefits and services that parts A and B cover. They may also offer extra benefits, such as prescription drug coverage, dental, vision, hearing, and other services. Medicare Advantage plans usually have additional fees such as copays and deductibles. Some plans have no premiums, but if the plan you choose has a premium, it may be deducted from your social security check

Part D (prescriptions)

Medicare Part D covers prescription drugs. The cost or premium for this plan depends on your income, and your copayments and deductible depend on the type of medications you need.

Medicare provides a list, called a formulary, of drugs each Part D plan covers so that you will know if the medications you need are covered by the plan you are considering.

Medicare supplement (Medigap)

Even though Medicare supplement isn’t called “part,” it is one of the five major types of Medicare insurance for you to consider. Medigap works with original Medicare and helps cover the out-of-pocket costs that original Medicare does not.

Medigap is sold by private companies, but Medicare requires that most states offer similar coverage. There are 10 Medigap plans available: A, B, C, D, F, G, K, L, M, and N. Each plan is slightly different in the specifics of what it covers.


How to get Medicare

You’ll automatically be enrolled in the program if you’re already receiving social security benefits. If you aren’t already receiving benefits, you can contact the social security office up to three months before your 65th birthday to enroll.

The Social Security Administration handles Medicare enrollment. There are three easy ways to apply:

  • Using the Medicare online application at the Social Security Administration’s website
  • Calling the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778)
  • Visiting your local Social Security Administration office

If you’re a retired railroad employee, contact the Railroad Retirement Board at 1-877-772-5772 (TTY: 1-312-751-4701) to enroll.

Tips for choosing a Medicare plan

When choosing the Medicare options to meet your healthcare needs, it’s important to consider your healthcare needs. Here are a few tips for choosing a plan or combination of plans to work for you:

  • Try to estimate how much you spent on healthcare last year that way you can better estimate which plans will save you money.
  • List your medical conditions so you can be sure they are covered by the plans you consider.
  • List the doctors you currently see and ask if they accept Medicare or which Health Maintenance Organizations (HMO) or Preferred Provider Organization (PPO) networks they may be in.
  • List any medical treatment or hospitalizations you may need in the upcoming year.
  • Note any other insurance you have, if you can use it with Medicare, and how to end that coverage if necessary.
  • Do you need dental work, wear glasses or hearing aids, or would you like other additional coverage?
  • Do you or are you planning to travel outside your coverage area or out of the country?

All of these factors can help you decide which parts of Medicare may best meet your needs and which individual plans to consider.

While Medicare original Medicare provides coverage for many services, not every medical situation is covered. For example, long-term care is not considered part of Medicare. If you need long-term care, consider a Medicare Advantage or Medigap plan which may offer limited long-term care benefits.

Since prescription drugs aren’t covered by original Medicare, if you need prescription drug coverage, you will need to enroll in Medicare Part D or Medicare Advantage, which offers plans that cover some prescription drugs.

Who is eligible for Medicare?

If you are 65 years old and eligible for Social Security, then Medicare is an option for you. If you’ve received Social Security Disability Insurance (SSDI) for 24 months, Medicare becomes available. Individuals who have certain disabilities, such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or permanent kidney failure, are automatically eligible.

Is Medicare free?

For most individuals, Medicare Part A is free, due to their payment of payroll taxes under the Federal Insurance Contributions Act (FICA). Individuals can also qualify for free Medicare Part A due to the work history of a spouse. If an individual does not qualify, then they will have to pay a premium for Medicare Part A. Other types of Medicare require a premium payment.

Is Medicare insurance?

Medicare covers healthcare costs for eligible individuals in the same way that health insurance does, but that’s where the similarity ends.

There is no premium for the basic part of Medicare, but coverage is more limited than private health insurance. Private health insurance often allows you to extend coverage to dependents, such as your spouse and children. Medicare, on the other hand, is individual insurance. Most people with Medicare coverage have to qualify on their own through age or disability.


What is not covered by Medicare?

Several key healthcare costs still aren’t covered by Medicare. The biggest of these is long-term care, also known as custodial care.

Medicaid, the federal health program for those on low incomes, pays these custodial costs, but Medicare doesn’t.

Common expenses that Medicare does not cover include:

  • Eye exams and eyeglasses
  • Dentures
  • Most dental care
  • Medical care overseas
  • Cosmetic surgery
  • Massage therapy

What is Medicare Advantage?

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. Some plans offer non-emergency coverage out of network, but typically at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Below are the most common types of Medicare Advantage Plans.

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

How Do Medicare Advantage Plans Work?

Medicare Advantage health care plans work like the employer-sponsored health insurance plans you may be used to from your previous or current job.

Medicare Advantage plans provide comprehensive coverage, and you usually need to stay in-network to receive care. You’ll typically have some out-of-pocket expenses when you receive services and procedures under your Medicare Advantage policy. These costs typically come in the form of copayments or coinsurance that you’ll pay to your provider when you receive care.

An important point to remember is that all Medicare Advantage plans have an annual out-of-pocket (OOP) maximum that limits the total amount you can spend in any year. But you do not have an OOP with Original Medicare.

What are the Advantages and Disadvantages of Medicare advantage Plans?

What are the benefits and drawbacks of Medicare Advantage? There are pros and cons to having this type of plan. Let’s take a look at them:

Advantages of Medicare Advantage

  • There’s a maximum cap on out-of-pocket costs for each year
  • Most MA plans include prescription drug coverage
  • There are often additional benefits included, such as vision and dental coverage, health club discounts, and more
  • You have more clarity on your out-of-pocket costs because MA plans generally have copayments rather than coinsurance percentages like Original Medicare
  • Some MA plans are available at no additional cost above your Part B premium

Disadvantages of Medicare Advantage

  • Plans may have a limited network of doctors focused in a single geographic area
  • You may have to coordinate your care through a primary care physician and get referrals to specialists
  • There may be no insurance coverage for doctors outside the plan’s network, including when you travel
  • You may not be able to combine your health coverage from retirement benefits with MA, and choosing an MA plan may cause you to lose other coverage and be unable to get it back

What is Original Medicare?

Original Medicare, also known as traditional Medicare, works on a fee-for-service basis. This means that you can go to any doctor or hospital that accepts Medicare, anywhere in the United States, and Medicare will pay its share of the bill for any Medicare-covered service it covers. You pay the rest, unless you have additional insurance that covers those costs. Original Medicare provides many health care services and supplies, but it doesn’t pay all your expenses.

When you first sign up for Medicare Part A and Part B, Social Security automatically enrolls you in original Medicare. If you prefer to receive your care from a private Medicare Advantage plan, such as an HMO or PPO, instead of the original program, you must actively enroll in a plan that’s offered in your area. If you prefer to stay in original Medicare, you can get prescription drug coverage by joining a private Part D drug plan for an additional premium; and you can also choose to buy private supplemental insurance (known as Medigap) to cover some of your out-of-pocket costs in the original program.

What is the Difference Between Original Medicare and Medicare Advantage Plans?

Original Medicare.

The primary difference between these programs is that Medicare Advantage is an alternative to Original Medicare. When you join a Medicare Part C plan, you no longer receive your Medicare benefits through Original Medicare.

Medicare Advantage plans

Medicare Advantage plans are offered and administered by private insurance companies. But these private insurance companies must comply with many rules and regulations set by the Medicare program.

What does Medicare Advantage cover?

Medicare Advantage plans offer both hospital and medical insurance coverage and additional coverage. Depending on the type of plan you choose, you also may be covered for:

  • Prescription drug coverage. While this isn’t usually offered under original Medicare, almost all Medicare Advantage plans offer prescription drug coverage.
  • Dental, vision, and hearing. This includes non-medically necessary coverage, which isn’t offered under original Medicare. Most Medicare Advantage plans differ in the amount of coverage for these options.

In addition, some companies offer other health-related perks under their Medicare Advantage plans, such as gym memberships, medical transportation, and meal delivery.

What does Medicare Advantage cost?

When you sign up for a Medicare Advantage plan, your costs will vary from plan to plan and based on where you live. A Medicare Advantage plan can come with its own monthly premium and yearly deductible, which is sometimes added on top of the Part B premium.

One benefit of a Medicare Advantage plan is that there’s a yearly cap for most other out-of-pocket costs, which may help lower your overall costs.

The total cost of a Medicare Advantage plan is generally determined by premiums, deductibles, copayments, how often and where you seek services, the types of services you need, and whether you receive Medicaid.

Given all these factors, there’s no one specific cost for a Medicare Advantage plan. These are all important things to consider when you compare plans.

Medicare Supplemental Insurance:


What is Medigap?

Medigap is Medicare supplemental insurance sold by private companies to help cover original Medicare costs, such as deductibles, copayments, and coinsurance.

In some cases, Medigap will also cover emergency medical fees when you’re traveling outside the United States. A Medigap policy only pays out after both you and Medicare have paid your share of costs for medical services.

There are 10 Medigap plans available: A, B, C, D, F, G, K, L, M, and N.

Some Medigap plans no longer for sale to new Medicare enrollees. These include plans C, F, E, H, I, and J. However, if you already have one of these plans, you can keep it. If you were eligible for Medicare before January 1, 2020, you can still buy Plan C or Plan F.

What do Medigap plans cover?

Most of these Medigap plans differ in what types of copayment, coinsurance, or other medical fees they will cover.

All Medigap plans cover at least some portion, if notall, of:

  • Medicare Part A coinsurance and hospital fees
  • Medicare Part A hospice coinsurance or copayment costs
  • Medicare Part B coinsurance or copayment costs
  • Blood transfusion costs, up to the first 3 pints

In addition, some Medigap plans also cover:

  • Skilled nursing facility costs
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Medicare Part B excess charges
  • Emergency medical costs during foreign travel

What’s not covered?

Medigap policies are supplemental insurance for original Medicare, not additional coverage. While a Medigap policy can help cover some of your Medicare costs, it will not cover:

  • Prescription drugs
  • Vision, dental, or hearing care
  • Any other health perks, such as fitness memberships or transportation services

To receive coverage for these types of medical services, you’ll need to add a Medicare Part D policy onto your plan or choose a Medicare Advantage (Part C) plan.

How much do Medigap plans cost?

There are some costs associated with both original Medicare and Medigap, which vary from plan to plan.

Monthly premium

Even with a Medigap plan, you’re still responsible for paying your original Medicare premiums. In 2021, these costs include:

  • $259 to $471 per month for Part A, although most people qualify for premium-free Part A
  • $148.50 per month for Part B, depending on your income

In addition, you may owe a separate premium for your Medigap plan.


Before Medicare or Medigap will pay for your services, you must meet your deductible amounts for parts A and B. For 2021, these include:

  • $1,484 for Part A per benefit period
  • $203 for Part B for the year

Some Medigap plans may pay for a portion (or all) ofthese deductible amounts.

Copayments and coinsurance

After your deductible has been met, Medicare pays out for its portion of the costs. However, you will still owe some copays or coinsurance fees in 2021, including:

  • $0 to $742 coinsurance per day for Part A services, depending on how many days you’ve been admitted as an inpatient
  • 20 percent of the Medicare-approved amount for items and services covered by Part B

Depending on the policy you choose, these copayment and coinsurance amounts will be paid out by your Medigap plan.

Out-of-pocket costs

Only two Medigap policies, K and L, have limits on how much you’ll pay out of pocket.

However, neither Medicare Part A nor Part B have out-of-pocket limits. If you choose a Medigap policy that doesn’t cover least most, or all, of your Medicare fees, you’ll still have to pay out-of-pocket for these costs.

How are Medigap plans priced?

Medigap policies are priced or “rated” according to a variety of factors. How a place is rated can influence how much you pay for your plan premium.

Community rated
Community-rated Medigap policies charge the same monthly premium regardless of your age. The monthly premium may change because of outside factors such as inflation, but it will never change based on your age.

Issue age rated
Issue-age-rated Medigap policies charge different premium amounts depending on your age when you purchased the policy. Generally, premiums are less expensive if you purchase a Medigap policy when you’re older.

Attained age rated
Attained age–rated Medigap policies charge higher premiums as you age, and your monthly premium amount is determined based on your age. Unlike issue-age-rated policies, these types become more expensive as you get older.

Other factors
Only four states Trusted Source offer Medicare beneficiaries guaranteed access to Medigap policies, regardless of health status.

In other states, if you have a preexisting health condition, you may be charged a higher premium for your Medigap policy.

Does Medigap cover you when you travel?

If your Medicare plan doesn’t already cover foreign travel, the following Medigap plans will cover 80 percent of your emergency healthcare services when you are traveling outside the United States:

  • Plan C
  • Plan D
  • Plan F
  • Plan G
  • Plan M
  • Plan N

In addition, although plans E, H, I, and J are no longer sold, they also cover travel-related health care expenses if you’re already enrolled in them.

Before a Medigap policy will pay out for foreign travel emergency costs, you will first need to pay a $250 deductible out-of-pocket. Your Medigap policy will then pay 80 percent of your emergency medical costs, up to a lifetime limit of $50,000.

It’s important to note that a Medigap policy will only pay for these types of fees if the policy begins during the first 60 days of your trip.

When can I enroll in Medigap?

There are multiple enrollment periods for Medicare plans, but there are only certain times when you can add a Medigap policy to your plan. The Medigap enrollment periods are:

  • Initial enrollment period. You are eligible to apply for a Medicare plan, and add a Medigap policy during the 3 months before, 3 months after, and month of your 65th birthday.
  • Open enrollment period. If you miss initial enrollment, you can apply for a policy during the Medigap open enrollment period. If you’ve already turned age 65, this period begins when you enroll in Part B. If you’re turning age 65, this period runs until 6 months after your turn 65 years old and have enrolled in Part B.

Insurance companies aren’t required to sell you a Medigap policy, especially if you’re under age 65.

Once the initial enrollment period and open enrollment period have passed, you may have a harder time finding an insurance company that will sell you a plan. As soon as you enroll in Medicare Part B, you should apply for a Medigap policy if you’d like one.

Also, keep in mind that you can’t buy a Medigap policy if you have a Medicare Advantage plan. You can only add Medigap to your coverage if you have original Medicare.

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