YOUR MEDICARE OPTIONS
Turning 65 and becoming Medicare eligible can be an overwhelming experience. This could be the very first time you have to choose your own health plan and it can seem like every insurance company is fighting for your business.
At Paladin Health Brokers, Medicare is our primary focus. We understand that there is no one-size-fits all Medicare solution. Our goal is to provide sound advice from knowledgeable agents so that your transition to Medicare is as painless as possible. We are proud to be an independent organization, which means we are not beholden to any one insurance company. We will be at your side as your partner and advocate to assist you in selecting the best possible Medicare plan. As your partner, we will be here to advocate for you now and in the future.
Original
Medicare
Prescription
Drug Care
Medicare
Supplements
Medicare Advantage
What Are The Parts of Medicare?
When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare: Original Medicare and Medicare Advantage.
Part A (Hospital Insurance)
Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care
Part B (Medical Insurance)
• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment
(like wheelchairs, walkers, hospital beds, and other equipment)
• Many preventive services
(like screenings, shots or vaccines, and yearly “Wellness” visits)
Part C (Advantage)
• Medicare Advantage is an “all in one” alternative to Original Medicare.
• These “bundled” plans include Part A, Part B, and usually Part D.
• Plans may have lower out-of-pocket costs than Original Medicare.
• In most cases, you’ll need to use doctors who are in the plan’s network.
• Most plans offer extra benefits that Original Medicare doesn’t cover—
like vision, hearing, dental, and more.
Part D (Prescription Drug Coverage)
Helps cover:
• Cost of prescription drugs
(including many recommended shots or vaccines)
Part D plans are run by private insurance companies that
follow rules set by Medicare.
Original Medicare
(also known as Parts A and B)
Part A and Part B
You can add: Part D
You can also add a Medicare Supplement
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Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
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If you want drug coverage, you can join a separate Part D plan.
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To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
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Can use any doctor or hospital that takes Medicare, anywhere in the U.S.
Medicare Advantage
(also known as Part C)
Part A and Part B
Most plans include: Part D
Most plans include: Extra Benefits
A Medicare Advantage Plan is another way to get your Medicare 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. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. However, many plans offer out-of-network coverage, but sometimes 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.
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Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
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Plans may have lower out-of-pocket costs than Original Medicare.
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In most cases, you’ll need to use doctors who are in the plan’s network.
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Most plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, dental, and more.
Medicare Prescription Drug Coverage
(also known as Part D)
Medicare prescription drug coverage is an optional benefit. Medicare drug coverage is offered to everyone with Medicare. Even if you don’t use prescription drugs now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage. To get Medicare prescription drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can vary in cost and specific drugs covered.
There are 2 ways to get Medicare prescription drug coverage:
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Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and/or Part B to join a Medicare Prescription Drug Plan.
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Medicare Advantage Plans or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.
In either case, you must live in the service area of the Medicare drug plan you want to join.
Supplemental Medicare Insurance Policies
(also known as Medigap)
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.
Medigap policies are standardized. Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F, G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
HOW TO COMPARE MEDIGAP POLICIES
The chart below shows basic information about the different benefits that Medigap policies cover for 2023. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you’re responsible for the rest.
Frequently Asked Questions
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What is Medicare Advantage?Medicare Advantage (Medicare Part C) is a way to receive your Medicare Benefits through a Private Insurance company. All plans cover the benefits found in Medicare Parts A & B, and most plans include Part D Prescription Coverage.
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What is the difference between a Medicare Supplement (Medigap) and Medicare Advantage (Part C)?Medicare Supplements are simply a secondary insurance that pays after Medicare has paid their part for your coverage. They “cover the gaps” that Medicare leaves you. Medicare Advantage is a one-stop-shop. When you have a Medicare Advantage plan, the private insurance company is responsible for you Medicare Coverage.
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Are Medicare Advantage plans less expensive than Medicare Supplements?In general Medicare Advantage plans have lower monthly premiums than Medicare Supplements, but it is possible that your out-of-pocket costs could be higher. Everyone’s situation is different, so it is a good idea to speak to a professional to help you sort things out. Click here to make an appointment.
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Do Medicare Supplements have Presecription Drug Coverage?No. Medicare Supplements that are offered today do not include drug coverage. You will need to purchase a standalone Part D plan for prescription drug coverage.
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Can I have Medicare Advantage and a Medicare Supplement at the same time?No. You can either have Medicare Advantage or a Medicare Supplement, but not both.
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Is there a monthly premium for Medicare?Yes, there is monthly premium for Part B coverage. Most people will pay $144.60 in 2020 for Part B unless you are subject the Income Related Monthly Adjustment Amount (IRMAA). IRMAA may also apply to Part D coverage.
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If I do not sign up for Medicare will I have to pay a penalty?It depends. If you are still working and have creditable coverage, you should not have to pay a penalty for Part B or Part D. If you simply decide to opt out of Medicare and the decide that you need it later then you will likely incur a penalty.
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How is the Part D Penalty calculated?The Part D penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2020), times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. Note: the penalty can change annually because the national base premium can change each year.
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How is the Part B Penalty calculated?If you didn't get Part B when you were first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up.
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Is there a cost for Medicare Part A?Generally speaking, most people do not pay a monthly premium for Part A. If you do have to pay for Part A, you can pay up to $458 each month in 2020. This will typically only apply to you if you have paid Medicare taxes for less than 30 quarters.