Medicare 101

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What is Medicare?

Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

The different parts of Medicare

The different parts of Medicare help cover specific services.

Part A (Hospital Insurance)

Helps cover:

Inpatient care in hospitals
Skilled nursing facility care
Hospice care
Home health care

Part B (Medical Insurance)

Helps cover:

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 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.

Location

Your Medicare Store

1235 S Gilbert Rd

Suite 14

Mesa, AZ 85204

Tel: (602) 770-3714

info@YourMedicareStoreAZ.com

Hours

We are open Monday through Friday

9 am - 5 pm and

by appointment any time.

We often all go out on appointments so occasionally there won't be anyone in the office. We'll always leave a sign on the door with our estimated return.

Feel free to call or text us at

(602) 770-3714 for immediate service.

Part C (Medicare Advantage Plans)

Medicare Advantage Plans are another way to get your Medicare Part A and Part B 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. Most Medicare Advantage Plans include drug coverage (Part D). In many cases, you will need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some 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. Below are the most common types of Medicare Advantage Plans.

Health Maintenance Organization (HMO) Plans
Preferred ProviderOrganization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNPs)

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
If you want drug coverage, you can join a separate Part D plan.
To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
Can use any doctor or hospital that takes Medicare, anywhere in the U.S.

Includes

Part A
Part B

You can add:

Part D

You can also add:

Supplemental coverage: Some examples include coverage from a Medicare Supplement Insurance (Medigap) policy, or coverage from a former employer or union.)

Medicare Advantage (also known as Part C)

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.

Includes

Part A
Part B

Most plans include:

Part D
Extra benefits

Types of plans:

HMO
PPO
PFFS
MSA
Special Needs Plans

What is a Medigap policy?

A Medigap policy (also called Medicare Supplement) is an insurance policy that helps supplement Original Medicare and is sold by private companies. A Medigap policy can help pay some of the remaining health care costs that Original Medicare doesn't pay for covered services and supplies, like copayments, coinsurance, and deductibles. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. These are “gaps” in Medicare coverage.

If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigappolicy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.

Note: Medicare doesn’t pay any of your costs for a Medigap policy.

All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it.

Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.