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Ashford Insurance

Medicare 101

Medicare 101

How Medicare Works

Learning the Medicare lingo is the first step in understanding how Medicare works. There are lots of letters, plan names, and new terms to understand.

We want you to feel like you have a good grasp on Medicare so you can choose a plan that’s right for you. This page will help you understand the common terms and how the different types of Medicare plans on the market compare to each other.

Defining Parts A, B, C and D

Medicare has four parts. Parts A and B are called Original Medicare. They’re run by the federal government. Medicare Part C is called Medicare Advantage. You buy Medicare Advantage plans from private health insurance companies that contract with the government. They work with Original Medicare coverage. Part D covers prescription drugs. Many Medicare Advantage plans combine Parts A, B, and D in one plan. And each Medicare plan only covers one person.

Original Medicare vs. Medicare Advantage

Medicare Advantage plans are popular because of their convenience. Most plans combine medical and prescription coverage on one card. Some offer dental and vision coverage, too. And you’re able to predict your out-of-pocket costs better than you can with Original Medicare.

When you have Original Medicare, you pay 20 percent of the cost, or 20 percent coinsurance, for most medical services covered under Part B. Medicare Advantage plans use copays more than coinsurance. Which means you pay a fixed cost. You might have a $15 copay for doctor office visits, for example.

And with Medicare Advantage plans, you have an out-of-pocket maximum. That means once you spend a certain amount of money on health care each year, your plan pays 100 percent of the cost of services it covers. Original Medicare doesn’t have this cap. So, if you get sick, you’ll end up paying a lot.

Supplement Plans vs. Medicare Advantage

Medicare supplement, or Medigap, plans are another option. In a way, Medicare Advantage replaces Original Medicare and connects all the pieces together on one plan. Supplement plans don’t replace Original Medicare. It’s more like an extra you can add on top of Original Medicare.

Medicare Supplements (Medigap plans) help pay some of the out-of-pocket costs you have with Original Medicare. For example, your plan might pay the 20 percent coinsurance for doctor office visits.

But if you go this route, you’ll need to make sure you have prescription drug coverage. That means that if you don’t have a Part D plan through an employer or union, you may face a penalty if you don’t buy one on your own. And supplement plans don’t come with the extra benefits you often get with Medicare Advantage, like dental and vision coverage.

Supplement plans sit on top of Medicare Parts A, B and D. You can get complete coverage, but you still must coordinate all those pieces on your own. Medicare Advantage Part C gives you all the pieces with one cohesive plan.

More Medicare 101 Below

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Original Medicare is health coverage managed by the federal government. Generally, there is a cost for each service. In most cases, you can go to any doctor, other health care provider, hospital, or another facility that is enrolled in Medicare and is accepting new Medicare patients. 

If you are receiving Social Security benefits before turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals must apply by calling or visiting their Social Security office to receive Medicare.

The way Medicare pays is, you generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies.

Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services.

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).

Do you have to pay for Medicare? Yes, most people will pay Medicare premiums. Fortunately, it’s fairly easy to get together a Medicare cost estimate so that you can plan ahead.

Need help? Call us for an appointment at (817) 952-3153

Ashford Insurance is an independent health insurance agency specializing in Texas & Oklahoma Medicare insurance. Ashford Insurance is here to help you understand Medicare in simple, plain terms that anyone can understand.  We specialize in helping folks who are Medicare eligible to learn about the coverage options available through the Medicare Health Insurance Program. 

Ashford Insurance Agents

Our Products

Here is a partial list of the products offered by Ashford Insurance

Medigap

Medicare Supplements

Advantage Plans

Medicare Advantage

Dual Plans

Got Medicare & Medicaid?

Chronic Plans

Have a chronic illness?

Prescription

Prescription Drug coverage.

Dental Plans

Dental Insurance

Vision Plans

Vision Insurance

Life Insurance

Several Types

Funeral Insurance

Burial Insurance

Short Term Medical

Temporary Insurance

Health Insurance

ACA FFM Exchange

Notary Services

Notary Public

Contact Form

(817) 952-3153

M-T 9:00 – 4:00
F 9:00- 12:00

Weekends & Evenings by Appointment

Address

 1245 Southridge Court Suite 101, Hurst, TX, 76053

* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.

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