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Part A
Part A
Part A
In a word...HOSPITAL
Part A is the part of Medicare that covers inpatient care at a hospital. It also covers skilled nursing facility, and Hospice, and Home Health Care. (But not entirely)
Part B
Part A
Part A
In a word... DOCTORS
Part B is (for the most part) outpatient care such as doctor office visits. It also includes outpatient tests (like x-ray, MRI and most bloodwork.
Part D
Part A
Part D
In a word.. DRUGS
Part D covers your prescription drugs (mostly). If you don't get it when you're first eligible you may face lifetime penalties. (Yes, there are exceptions)
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Medicare Advantage (Part C)
This is NOT actually Medicare. When you have Part C (Medicare Advantage) you are disenrolled from Medicare and your healthcare is covered by a private insurance company with whom the government has contracted. You cannot use your Medicare card when you have Part C. There are checks and balances in place to make sure that individuals who choose Part C, get the equivalent level of care as those who stay on Medicare and coverage doesn't have to be exactly the same. Part C patients must stay within a required network of doctors (or pay higher copays if allowed to go outside of the network).
Medicare Supplement (Medigap or Part E)
This is also NOT Medicare but the difference between Part C and Part E is that you are not taken off of Medicare when you have Part E. In fact, you will use your Medicare card with Part E because Part E covers the difference (the gap) between what Medicare pays (usually 80%) and what it doesn't (the other 20%). Other differences include the freedom to go to any US doctor that accepts Medicare, and no prior authorizations or referrals. ALL Medigap plans that have the same letter designation (e.g. Plan G) have the same exact benefits regardless of company. So, when comparing Medigap plans, consider the stability of the insurance company and price.
Popular MediGAP Plans (MediCare Supplement or part e)
Plan F
- In earlier years, Plan F was considered the "Cadillac" plan because it covered all of the deductibles and copays that Original Medicare does not cover.
- Plan F is usually the most expensive Medicare Supplement (Medigap) plan.
- Today, Plan F is only offered to those individuals who turned 65 before 2020.
- Experts predict that as the population of seniors covered by Plan F declines (through death and attrition), the rates for these plans will continue to soar.
Plan G
- Plan G has the same coverage Plan F except Plan G does not cover the Part B deductible.
- Plan G has a lower monthly premium than Plan F.
- Plan G is also the plan that people can choose without answering health questions when they are eligible for guaranteed issue coverage. Guaranteed coverage means no health questions are asked on the application. In other words, you can't be denied for health reasons. [For example: You are new to Medicare (e.g. turn 65 and/or lose employer coverage or the Medicare Advantage plan (Part C) is no longer offered in your area.
Plan N
- Plan N has the same coverage as Plan G with two exceptions:
- Copay: Plan N requires a copay up to $20 for some office visits and up to $50 for an emergency room visit (waived if you're admitted to the hospital).
- Excess charges: In some states, doctors are allow to charge up to 15% more than what Medicare covers. These are called "excess charges." [For example, if the doctor charges $200 for an office visit but Medicare only allows $125, Medicare will pay the doctor $75. You will pay a $20 copay (which totals to 80%) and the doctor can charge you $18.75 more (15% over the Medicare allowable amount of $125). In this example, you would pay $38.75 for the office visit, UNLESS you live a State that don't allow excess charges]. See list below.
- Plan N premium is usually lower than Plans F and G. When shopping rates between Plans G and N, factor in how often you go to the doctor. [For example: If you only see the doctor once or twice a year and Plan G is $100/month but Plan N is $80/month, you would save between $200-$220 per year on Plan N, even paying copays].
States in which excess charges are not allowed:
- Connecticut
- Massachusetts
- Minnesota
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Vermont
Frequently Asked Questions
Do you have a question that is not answered below? Email rich@seniorscovred.com if you cannot find an answer to your question and we may add it here!
- You can't have Part C (Medicare Advantage) and Part E (Medigap) at the same time. It's against the law.
- You can't have Part C if you don't have Part B (or if you're not eligible for Part A.
- Most Medicare Advantage Plans include prescription drug coverage. Some insurance carriers advertise that this is "Part D" drug coverage but it is not Part D. The formularies (list of drugs covered) is not the same.
- So, the simple answer is, No. You can't have Part C (Medicare Advantage) and Part D (Prescription Drug coverage) together.
- There are exceptions but they don't apply to most people. For example, there is a Part C
- No. You can only enroll in Medicare Advantage (Part C) during the Annual Enrollment Period (October 15 - December 7) unless you have a qualifying reason that would allow you to enroll outside of these dates.
- No. You can only enroll in a (Part D) Prescription Drug plan during the Annual Enrollment Period (October 15 - December 7) unless you have a qualifying reason that would allow you to enroll outside of these dates.
- Even though you are not enrolled in Original Medicare anymore when you enroll in Medicare Advantage, you are required to pay for Part B of Medicare.
- Not always. There are times when you don't have to answer any health questions when enrolling in Part E (Medigap or Medicare Supplement). But even if you do have to answer health questions, as long as you don't have a serious illness such as cancer, a major heart issue (e.g. A-fib) or an autoimmune disease (e.g. multiple sclerosis, Parkinson's) you may qualify for Part E
- No. Medicare Advantage plans have to accept all health conditions but the enrollment window is limited to between October 15 and December 7 each year.
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