Medicare Coverage Guide | Medicare Basics

Medicare Basics

Many people qualify for a Special Election Period (SEP) which allows them to change plans anytime during the year. Call us today to see if you qualify!

What are the parts of Medicare?

PART A (HOSPITAL)

Helps cover the following (including, but not limited to):

Inpatient hospital care
- Semi-private room
- Meals
- Drugs, supplies, equipment
- Lab and x-ray
- Operating room/recovery services
Blood transfusions (hospital or skilled nursing facility
In and out rehabilitation services after a qualified inpatient stay
Some in-home skilled nursing care (restrictions apply)
Hospice

Part B (Medical)

Helps cover the following (including, but not limited to):

Doctor visits in and out of hospital
Preventative services
- Flu shots
- Mammograms
- Annual physical
- Many more!
Lab tests (Blood work)
MRI, CT scans, X-rays, & other diagnostic tests
Outpatient Physical, Occupational, & Speech/language therapy
Diabetes screening, education, & supplies
Mental Health Care
Durable Medical Equipment (example: wheelchair, crutches, prosthetics)
Ambulatory Surgical Center Services
Ambulance (ground or air), Emergency Room, & Urgent Care

Both parts A and B of Medicare have restrictions & limitations on covered services provided. Although these services are covered, you are responsible for any deductibles, co-pays, & co-insurances left behind by Medicare. This is why you should have a Medicare Supplement or Advantage plan. Call us today!

Part D (Prescription drug coverage)

Provided by private insurance companies overseen by Medicare
Helps cover cost of prescription drugs
- Generic
- Brand
- Specialty
- Vaccines & Shots
Can be a separate plan
- Example: Medicare Supplement plan and a Prescription Drug Plan
Can be included in a Medicare Advantage plan
- Example: Medicare Advantage plan that covers both medical and prescription drugs all in one plan.
Premiums, Co-pays, & Deductibles can be subsidized for eligible beneficiaries.
Prescription brands covered, co-pays, co-insurance, premiums, deductibles, and pharmacy networks are different between plans.

PART C (Medicare Advantage)

Combines Medicare Parts A & B. Most plans also include Part D and extra benefits into one plan often with no additional premium.

Plans often have no to low premiums
Most plans offer some or all of the extra benefits
- Dental
- Eye glasses & Hearing Aids
- Free over the counter supplies
- Gym membership
- Wellness programs
- Transportation
- 24 hours nurse hotline
- Food allowance
- Part B premium reduction
Have network of providers
Coordinated Care

Your Medicare options

There are 7 coverage combinations that a Medicare beneficiary with Parts A & B can elect to be covered for their health care needs. See Below.

Original Medicare (Part A and/or Part B) alone