mEDICARE: WHAT YOU NEED TO KNOW

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* People age 65 or older

* People under age 65 with certain disabilities

* People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.  Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care).  It also helps cover hospice care and some home health care.  Beneficiaries must meet certain conditions to get these benefits.

Most people pay a monthly premium for Part B.  Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care.  It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care.  Part B helps pay for these covered services and supplies when they are medically necessary.

Medicare Part C, also known as Medicare Advantage are plans available through private health insurance companies and replace Original Medicare.  Medicare Advantage plans typically includes everything covered by Medicare Part A (hospital insurance) and Part B (medical insurance) in addition to extra benefits and may or may not include a Medicare prescription drug benefit.

Medicare Part D  is a component of Medicare that is offered by Medicare-approved private companies and helps cover the cost of prescription medications, potentially lowering  drug expenses and protecting against higher costs in the future.   Beneficiaries choose the drug plan and pay a monthly premium.  If a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

A Medicare Supplement (Medigap) is sold by private companies and is different from a Medicare Advantage Plan.  It helps pay some healthcare costs that Original Medicare doesn't cover like copayments, coinsurance, and deductibles.

Medicare Supplement policies are standardized into 10 plans - labeled "A" through "N", each with its own set of benefits. Plan A covers the most basic benefits. These basic benefits are also covered in each of the remaining Medicare Supplement plans - B through N. Plans B through N provide additional coverage beyond the basics.

While the costs of these policies may vary, individual insurance companies must provide the same standardized benefits.  To purchase a policy, in general you must be enrolled in Medicare Part A and Part B.  In addition to paying the monthly Medicare Part B premium to Medicare, you will have to pay a premium to the insurance company providing your coverage.   You will also pay a premium for Part D, prescription drug plan. 

• Covers gaps in Medicare:  Original Medicare only covers a portion of medical costs, so a Medigap plan can help pay for the remaining amount you would otherwise have to pay out-of-pocket. 
• Freedom to choose providers:  Unlike some Medicare Advantage plans, Medigap allows you to see any doctor who accepts Medicare, giving you flexibility in choosing healthcare providers. 
• No network restrictions:  You can access care from any Medicare-participating provider without needing referrals.