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Introduction To Medicare

The information you need to choose the Medicare coverage that’s right for you is all here. We’ll guide you through it step by step.

Medicare Basics

Parts of Medicare

Coverage Options

Enrollment

Parts of Medicare

What Are the Parts of Medicare?

Medicare has four different parts that provide coverage for specific services. Learning what each part covers can help you better understand your options and feel more confident about your decisions.

Medicare Part A (Hospital Coverage)

Together, Medicare Part A and Medicare Part B are known as Original Medicare. Medicare Part A is hospital insurance that provides coverage for:
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Inpatient care
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Skilled nursing facility care
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Hospice care
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Some home health care
Most people don’t pay a monthly premium for Medicare Part A. It’s coverage that’s earned from Medicare taxes that you or a spouse have paid while working. If you don’t qualify for premium-free Part A, you can also buy Part A coverage. Our licensed insurance agents can help guide you through that process.

Medicare Part B (Medical Coverage)

Together, Medicare Part A and Medicare Part B are known as Original Medicare. Medicare Part B is medical insurance for medically necessary services and preventive services. It provides coverage for:
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Doctor's services
House with a medical cross on the front
Outpatient care
Ambulance
Ambulance services
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Clinical research
Heart monitor with a squiggly line and a heart on the screen
Durable medical equipment
Prescription bottle with a medical cross and two pills to the right
Limited prescription drugs
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Mental health
White hands reaching up toward a blue medical cross
Early stage preventive services
Most people will pay a monthly premium for Medicare Part B. The standard amount is set each year and may increase based on your gross income as reported to the IRS.If you receive benefits from Social Security, the Railroad Retirement Board or the Office of Personnel Management, your Part B premium is automatically deducted from Security benefit payment. Or you can choose to have your Part B premium deducted from your social security check. Otherwise, you will receive a bill.You’re not required to enroll in Medicare Part B during your Initial Enrollment Period. However, in many cases delaying enrollment means you’ll have to pay a late enrollment penalty for as long as you have Part B coverage. We can help you decide if enrolling in Part B is right for you.

Medicare Part C (Medicare Advantage)

Medicare Part C, commonly known as Medicare Advantage, is coverage offered by private insurance companies that have a contract with the federal government. Medicare Advantage combines your Part A hospital, Part B medical and often Part D prescription drug coverage into one plan.
  • Provide all the benefits of Original Medicare (Parts A and B).
  • Often include extra benefits that Original Medicare doesn’t cover.
  • Limit the amount of money you pay out-of-pocket for medical expenses each year.
  • May require you to use providers within the plan’s network and charge you more when you use out-of-network providers.
  • Must notify you of any changes to the plan before the next enrollment year.
  • Are only available to you if you’re enrolled in both Medicare Part A and Medicare Part B.
With Medicare Advantage, you must continue to pay your Medicare Part B premium. You may also have to pay a monthly premium to the insurance company that provides your coverage.

Medicare Part D (Prescription Drugs)

Offered by private insurance companies, Medicare Part D coverage helps you pay for your prescription drugs. There are two basic ways to get Part D prescription drug coverage:
  • You’ll need both Part A and Part B to qualify for the full benefits that cover certain dialysis and kidney transplant services.
  • If you choose to join a Medicare Advantage plan that has prescription drug coverage, you won’t pay an extra premium for Part D — those benefits are included in your plan.
All Part D plans — including Medicare Advantage plans with Part D benefits — cover a wide range of prescription drugs. However, coverage and cost vary from plan to plan:
  • Each plan has a formulary — a list of the specific prescription drugs the plan covers.
  • Many plan formularies also have tiers that place covered prescription drugs into different cost levels.
  • Prescription drugs in a lower tier will generally cost you less than those in a higher tier.

Medicare Supplement (Medigap)

Original Medicare (Parts A and B) doesn’t cover everything. It only covers a portion of your costs for covered services — and it doesn’t limit what you pay out-of-pocket for health care expenses each year.To help fill these coverage gaps, many private insurance companies offer Medicare Supplement, or “Medigap”, insurance policies that help pay for your health care costs. When you have a Medigap policy, Medicare continues to pay its share of the approved amount for covered services. Your Medigap policy then pays its share.
Here are some important things to know about Medigap policies:
  • You must have Original Medicare (Parts A and B) to buy one.
  • They have a monthly premium that you pay to the insurance company.
  • You must also continue to pay your Medicare Part B premium.
  • They don’t include prescription drug coverage — you must purchase a Part D plan separately.
  • They generally don’t cover things like long-term care, vision, dental, hearing or private-duty nursing.
  • They only cover one person — if you and your spouse want Medigap coverage, you’ll each need separate policies.

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Coverage Options

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PlanEnroll represents Medicare Advantage HMO, PPO, PFFS, and Prescription Drug Plan organizations that have a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment depends on the plan’s contract renewal. Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period. Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and is used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll, PlanEnroll.com is a non-government website and is not endorsed by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (DHHS) or any other government agency.

We do not offer every plan available in your area. Currently we represent 0-78 organizations which offer 0-2,613 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

The exact carrier and plan counts are determined by your zip code and county.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance. If you are already a member, please contact your health plan to file a complaint.

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