(509) 992-4872     

What is Medicare

Medicare is a federal program that provides health coverage if you're 65 or older, or if you have a severe disability.

Learn More

Medicare Advantage

Offered by private insurance companies, these plans combine Part A, Part B and often Part D and include additional benefits such as dental, vision, hearing and fitness.

Learn More

Medicare Supplements

Often confused with Medicare Advantage (part C), supplemental insurance fills the gaps in original Medicare.

Learn More

What is Medicare

Medicare is a federal program that provides health coverage if you’re 65 or older, if you are under 65 and have certain disabilities, or if you have End Stage Renal Disease. In most cases it doesn’t matter what your income is unless you have earned over certain limits in the past 2 years ($87,000 annually if you file a single tax return & $174,000 annually for those filing jointly). If this applies to you please see Medicare.gov for information on the Income Related Monthly Adjustment Amount (IRMAA).
Summary Info: https://www.medicare.gov/your-medicare-costs/part-b-costs
Detailed Info: https://www.ssa.gov/benefits/medicare/medicare-premiums.html

So what are the pieces that make up Medicare?

Part  A - Hospital Insurance

Think of this as your access to hospitals. Typical coverage includes inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. It usually comes with no premium for those that have worked for more than 40 quarters (10 years).

Part B - Medical Insurance

Think of this as your access to doctors. It typically covers certain doctors' services, outpatient care, preventive services, and medical supplies. It requires a monthly premium which is $144.60 in 2020.
  • Original Medicare -- Medicare Parts A and B make up your basic Medicare coverage, also known as Original Medicare. This covers approximately 80% of approved Medicare expenses which leaves you responsible for the remaining 20%. There is no limit on how much that 20% may be. Basic Medicare coverage does not cover prescription drugs.

Part D - Prescription Drug Insurance

Prescription Drug Plans (PDP’s) are offered by private insurance companies and require a separate monthly premium. To cover your prescription drugs you must purchase a Prescription Drug Plan as an additional option to Original Medicare. Part D is an optional coverage however you may be penalized if you choose not to enroll and then later choose to enroll without having maintained equivalent coverage.
  • These plans must be Medicare approved and provide at least the standard level of coverage set by Medicare. The plans can choose what drugs they cover (called a formulary) but must cover at least two options in each drug category. They can also choose what Tier a specific drug will be covered at in their plan which will affect how much you will pay for that drug. Each plan has a different monthly premium and choosing the right plan for you is completely based on your individual needs.

Medicare Supplement Plans

also called MediGap Plans

Once you are enrolled in Medicare Parts A and B, you may elect to enroll in a Medicare Supplement Plan rather than a Medicare Advantage Plan. A Medicare Supplement Plan has limited enrollment opportunities, pays portions of expenses left by Original Medicare (Parts A and B) depending on which supplement plan you choose, requires a standalone Prescription Drug Plan and is typically used by those with higher health needs.
  • Medicare supplements are plans offered by private insurance companies that fill in the gap of the approximate 20% that Original Medicare leaves as your responsibility. If you can imagine Original Medicare (Parts A and B) as a box that is filled up to 80%, a Medicare supplement is designed to fill the rest of that box in varying levels up to almost 100%. Medicare supplements will only stay inside of the same box as that which original Medicare covers. As a result they do not cover things like dental, vision or hearing because Medicare does not cover them. Simply put, if Medicare doesn’t cover it neither will a Medicare supplement.

    Medicare supplements do have several benefits. First their coverage is nationwide because they do not have network restrictions like HMO’s. If a doctor accepts Medicare then they accept a Medicare supplement. Second, supplements provide peace of mind in knowing that regardless of how large a bill you incur for Medicare approved expenses, you will have little to no out of pocket costs. If you have higher health needs and visit doctors frequently, Medicare supplements allow you to even out your costs by just paying the supplement’s monthly premium and leaving the rest to your plan.

    Medicare supplements do not include prescription drug coverage however standalone prescription drug plans are available to meet this need.

    With a Medicare supplement plan you're prepaying for your care so you can rest easy knowing that whatever might come your way you are well protected.