The Basics of Medicare Supplement Insurance

Medicare is health insurance for

1.

  People age 65 or older

2.

  People under 65 with certain disabilities, including End Stage Renal Disease

You have two Medicare insurance coverage choices

1. Original Medicare

What is Original Medicare

Part A

Hospital Insurance

  • Inpatient Care
  • Inpatient Nursing Care
  • Inpatient Services and Supplies
What it covers

AND

Part B

Medical Insurance

  • Doctors' Services
  • Outpatient Care
  • Preventive Services
What it covers

OR

2. Medicare Advantage

Part C

Advantage Plans

  • Medicare Part A
  • Medicare Part B
  • May offer additional benefits
What it covers

Medicare Part A helps cover the following:

  1. Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)
  2. Inpatient care in a skilled nursing facility (not custodial or long-term care)
  3. Hospice care services
  4. Home health care services

You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working.

Medicare Part B helps cover some medically necessary services like:

  • Doctors’ services
  • Outpatient care
  • Home health care services
  • Medical services
  • Other medical services

You can find out if you have Medicare Part B by looking at your Medicare card.

You pay the Medicare Part B premium each month. Most people will pay the standard premium amount.

There are two kinds of Medicare Part B covered services:

  1. Medically-necessary services are services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  2. Preventive services include health care to prevent illness or detect it at an early stage, when treatment is most likely to work best (for example, Pap tests, flu shots, and colorectal cancer screenings).

Medicare eligible expenses shall mean expenses of the kinds covered by Medicare Parts A and B to the extent recognized as reasonable and medically necessary by Medicare.

A Medicare Advantage Plan (like an HMO or PPO) is another health coverage choice you may have as part of Medicare.

Medicare Advantage Plans, sometimes called Medicare Part C or MA Plans, are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. In all plan types, you’re always covered for emergency and urgent care.

Not all Medicare Advantage Plans work the same way. Out-of-pockets can vary, some plans require referrals to see specialists and many have provider networks.

Types of Medicare Advantage Plans include the following:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)


Part D

Optional Prescription Drug Coverage

Medicare Part D is a prescription drug option run by private insurance companies approved by and under contract with Medicare to help cover the cost of prescription drugs. It may help lower your prescription drug costs and help protect against higher costs in the future.