Leonard "Lenny" Rosen

• Medicare is a federal program that offers health insurance to American citizens and other eligible individuals.
• The program is often called Original Medicare.  It has two parts - Part A and Part B

U.S. citizens and legal residents

• Legal residents must live in the U.S. for at least 5 years in a row, including the 5 years just before applying for Medicare.

You must also meet one of the following requirements:

• Age 65 or older
• Younger than 65 with a qualifying disability
• Any age with a diagnosis of end-stage renal disease or ALS

 

Original Medicare (Parts A & B) provides many health care benefits

• Part A covers inpatient hospital and skilled nursing care.
• Part B covers doctor visits and outpatient care.

You can choose private plans to get more coverage

• Medicare Advantage plans (Part C) combine Part A and Part B coverage.  They often include drug coverage and other benefits you don't get with Original Medicare.
• Medicare Prescription drug plans (Part D) help pay for medications.  You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.
• Medicare Supplement Insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).

You can add coverage to Original Medicare or choose a Medicare Advantage plan instead.

• Original Medicare:  You may add a standalone Part D plan, a Medicare supplement plan or both to Original Medicare (Parts A & B)
• Medicare Advantage:  You may choose to get your benefits through a Medicare Advantage plan (Part C).  Many plans come with built-in prescription drug coverage.  you can add a standalone Part D plan only with certain Medicare Advantage plan types.

Medicare and many Medicare plans charge premiums

• A premium is a fixed amount you pay each month for coverage.

You also pay a share of the cost for health care services you receive.  The three kinds of payments you might have are: Deductible, Copay and Coinsurance

• Deductible - A set amount you pay out of pocket to covered services each year before Medicare or your plan begins to pay.
• Copay - A fixed amount you pay at the time you receive a covered service.  For example, you might pay $20 when you visit the doctor or $12 when you fill a prescription.
• Coinsurance - A percentage of the cost for a covered service that you pay when you receive it.  For example, you might pay 20% and Medicare or your plan would pay 80%.

Think about your needs so you can see how different coverage options might work for you.  Answer the following questions can help you get started.

Your Health

• How often do you go to the doctor?
• What health problems do you have?
• What medications do you take regularly?

Your Budget

• What are you able to pay each month in premiums?
• How comfortable are you covering copays or coinsurance for services?
• How willing are you to accept the risk of high out-of-pocket costs?

Your Preferences

• Which doctors, hospitals and pharmacies do you like to go to?
• How important is it for you to have access to health care while traveling?
• What other coverage do you have, such as an employer or retiree plan?