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Ashford Insurance

Grapevine Texas Medicare Insurance

Grapevine Texas Medicare

ORIGINAL MEDICARE

Parts A and B make up Original Medicare.  You can go to any doctor or hospital that accepts Medicare.  And you don’t need a referral to see a specialist.

Part A – Hospital Insurance

Part A covers you for inpatient care in a hospital or skilled nursing facility.

Most people do not pay a monthly premium for Part A.

But you are responsible for paying a deductible before Medicare starts to pay.  And this is a unique deductible because you could potentially pay it multiple times per year.

Co-insurance is what you pay after you have met your deductible.  When you are in the hospital you have to pay coinsurance per day for days 61-90 spent in the hospital. 

But if you are in a skilled nursing facility then you have to pay co-insurance for days 21-100.  Obviously, this cost can add up quickly if you spend a month or more in a skilled nursing facility.

Part B – Medical Insurance

Part B covers you for doctor visits, outpatient care like physical therapy, chemotherapy, and lab work.

In addition to that premium, you are responsible for paying a deductible before Medicare starts paying anything for part B.  After that Medicare pays 80% and you have to pay 20% of the costs. 

There is NO CAP to 20% of costs regardless of how large that bill is.  20% of $1,000 means you owe $200.  But 20% of $50,000 means you owe $10,000!

PRESCRIPTION DRUG COVERAGE

Maybe you noticed but Original Medicare doesn’t cover any prescription medications.  So what can you do to have coverage for something as important as medications?

Part D – Prescription Drug Coverage

These plans are offered by insurance companies and you normally have a choice of around 28 different plans with different premiums, different pharmacies you can use, and different costs for the same medications.

The average premium for Part D plans is around $35 per month.  But that is just the average so the actual premium can vary greatly.  

MEDICARE ADVANTAGE

Part C – Medicare Advantage

Medicare Advantage combines Original Medicare (Parts A + B) and often (prescription coverage) Part D.  A big difference from Original Medicare is this coverage is offered by insurance companies instead of the federal government. 

So you get your coverage from companies such as Dean, Humana, or United Healthcare instead of Original Medicare.  These companies set up a network of providers so your choice of doctors is more limited compared with Original Medicare.

Before selecting a Medicare Advantage plan it’s critical to find out if your doctor is in-network.  Otherwise, you could end up paying all of those costs on your own.