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Medicare 101

Medicare 101

Part of providing quality senior-focused care for our patients is arming them with the information they need to make informed decisions. Use the answers below to guide your Medicare journey and ensure you’re able to access the quality care you deserve.

What is Medicare?

Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services.

Who is eligible for Medicare?

Medicare benefits are intended for individuals who are 65 years or older, as well as those with one of the following qualifying conditions:

  • Certain disabilities lasting 24 consecutive months
  • End-stage renal disease (ESRD)
  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)

What kind of Medicare plans are out there?

Those eligible for Medicare have several plan options:

  • Original Medicare Plan (Part A and Part B)
  • Medicare Advantage Plan (Part C)
  • Medicare prescription drug coverage plan that may help cover the cost of prescription drugs and help protect against higher costs in the future (Part D).

What’s the difference between Original Medicare and Medicare Advantage?

After you have become Medicare-eligible and enrolled in the program, you can choose to receive your benefits directly through the federal government as part of the Original Plan, or from a company that contracts with Medicare as part of Medicare Advantage.

Use the chart below to compare the benefits of these two options.

Original Medicare
compare
Medicare Advantage
cash

Cost

Original Medicare

There’s no limit on how much you pay out-of pocket per year unless you have supplemental coverage.

cash

Cost

Medicare Advantage

Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year.

doctors bag

Coverage*

Original Medicare

Medicare covers medical services and supplies in hospitals, doctors’ offices and other health care settings. Services are either covered under Part A or Part B.

doctors bag

Coverage*

Medicare Advantage

Plans must cover all of the services that Original Medicare covers. Plans may offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.

hospital

Supplemental coverage

Original Medicare

You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.

hospital

Supplemental coverage

Medicare Advantage

It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.

medication

Prescription drugs*

Original Medicare

You’ll need to join a Medicare Prescription Drug Plan to get drug coverage.

medication

Prescription drugs*

Medicare Advantage

Most Medicare Advantage Plans include drug coverage.

doctor

Doctor and hospital choice

Original Medicare

You can go to any doctor who accepts Medicare.

doctor

Doctor and hospital choice

Medicare Advantage

You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of network coverage.

pills

Quality of care

Original Medicare

You can get a snapshot of the quality of care providers (and facilities) give their patients by visiting medicare.gov.

pills

Quality of care

Medicare Advantage

The Medicare Plan Finder at medicare.gov/find-a-planfeatures a star rating system for Medicare plans.

Travel insurance

Travel

Original Medicare

Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.

Travel insurance

Travel

Medicare Advantage

Plans usually don’t cover care you get outside of the U.S.

* If you have other types of health or prescription drug coverage, check to see how it works with the type of coverage you’re considering before you make any decisions or changes.

We can connect you with a licensed insurance agent who can help you understand your options. Call us at 702.623.0183 (TTY: 711) for more information.

How do I know if I’m eligible for Medicare Advantage?

You’re probably eligible if:

  • You have Medicare Part A and Part B
  • You live in the service area of the plan you want to join

When can I make the switch to Medicare Advantage?

You can make the switch during the Medicare Annual Election Period, which runs from October 15th to December 7th. If you’re turning 65, moving, or suffering from select chronic conditions, you may also be eligible to shift your Medicare plan during a Special Enrollment Period. See our Medicare Enrollment page for more details.

How can I learn more about my Medicare options today?

Making the most of Medicare means having access to the latest information.

Browse through these additional Medicare resources to help you navigate your options:

We understand it can be difficult to understand the complexities of Medicare options and we are dedicated to providing you with trusted resources to guide your journey.

For personalized advice, call us at 702-623-0183 to discuss your options.

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