What is Medicare?

Medicare is federal health insurance for people 65 or older, some younger people with disabilities, and people with End-Stage Renal Disease. Created in 1965

Medicaid is a joint federal and state program that provides health coverage for some people with limited income and resources.

Currently we represent 9 organizations which offer 44 products in your area.  You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.

• Plans work with Original Medicare. All claims go to Medicare first.
• Plans fill the gaps that Original Medicare leaves behind.
  • Deductibles, coinsurance, copayments
• Plans have Monthly Premiums
• Plans are sold by private insurance companies.
• Plans are standardized. All plans with the same letter have the same coverage.
  • Costs vary by plan and Company.

• Claims no longer go to Original Medicare but to a Private Insurance company
• Medicare pays an approved private Insurance company to administrate your Medicare benefits. These companies take on your risk and process all claims. These companies must follow rules set by CMS or Medicare.
• You must be enrolled in Medicare parts A and B to participate in a Medicare Advantage plan program. You remain in the Medicare program with all rights and protections.
• Can be charged different out-of-pocket costs. Vary from plan to plan.
• Can’t be charged more than Original Medicare for certain services, such as:
  • Chemotherapy, dialysis, and skilled nursing facility (SNF) care.
• May choose a plan with extra benefits like Dental, Vision, Hearing, OTC (over the counter), gym membership benefits, and Prescription Drug coverage.
• Have a yearly limit on out-of-pocket costs. Vary from plan to plan.
• Members have access to a network of doctors and hospitals. Networks and service areas vary from plan to plan. It is important to understand.

Medicare Cost Plans are health plans offered by approved private insurers that contract through the federal government to provide a full Medicare benefit package. Similar to Medicare Advantage plans in that enrollees have access to a network of doctors and hospitals. May be best described as a hybrid plan. Benefits include:

• Works with Medicare Part A and Part B.
• Premiums are not age or gender based
• Ability to change plans as needed
• No medical underwriting
  • Eligibility includes NOT having End Stage Renal Disease (ESRD)
• Extra benefits such as eye exams, hearing exams and fitness club memberships. Reimbursements for Dental benefits, Eyewear, and Hearing aids.
• Only available in certain Counties.

• An optional benefit available to all people with Medicare, There may be a penalty for enrolling late
• Run by private companies that contract with Medicare
• Premiums vary with plans
• Provided through
  • Medicare prescription drug plans (PDPs)
  • Medicare Advantage Prescription Drug Plans
  • Some other Medicare health plans (e.g. Medicare Cost Plans)
• Plans cover drugs on the Formulary (list of covered drugs)
• Stages of drug coverage include:
  • Deductible
  • Copay/coinsurance or cost sharing
  • Coverage gap
  • Catastrophic