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March 24, 2019 / Coverage Planning

Medicare: From A to D

March 24, 2019 3 min read

You are turning 65 and will soon qualify for Medicare Health Insurance. You have three months before your 65th birthday to sign up for Medicare to avoid premium increases.

But, what is Medicare?

Medicare is the health insurance program that the United States government offers people age 65 or older, people with disabilities, and patients with permanent kidney failure.

The two basic ways that Medicare enrollees can receive their coverage are known as Original Medicare and Medicare Advantage.

Original Medicare (OM)

Original Medicare is coverage managed by the government. OM allows you to go to any doctor or hospital that accepts Medicare anywhere in the U.S. and you don’t need a referral to see a specialist.
OM has different “Parts” covering different things:

  • Medicare Part A covers most costs related to hospital stays, skilled nursing facilities, care in a long-term hospital, eligible home health services, and hospice care. Medicare Part A is often free for Medicare enrollees who’ve paid payroll taxes for at least 10 years in the U.S.
  • Medicare Part B, covers doctor visits, lab work, outpatient services, preventive care, and durable medical equipment. The cost of Medicare Part B, which is optional, varies depending on whether the premium is deducted from your Social Security check. You need to satisfy a deductible before Medicare pays benefits.Medicare Part A and Part B both require deductibles and copays.
  • Medicare Part D is the term for Medicare Prescription Drug Plans, which help cover Rx medications. Medicare Part D is also optional, and plan costs vary.

People with OM may elect Medicare Supplement Insurance, also known as Medigap, supplemental coverage, to help with out-of-pocket expenses not covered by Parts A & B such as deductibles, copayments, and 20 percent doctor-visit coinsurance.

Medicare Advantage (MA)

Medicare Part C also known as Medicare Advantage plans provide medical and prescription medication coverage from a private insurer.

Medicare Advantage plans offer an alternative to signing up for Original Medicare with a Part D prescription plan and a supplemental plan. Enrollees pay Medicare Part B premiums, and usually a monthly premium for their Medicare Advantage plan.

MA plans often provide services that go beyond what Original Medicare covers, such as vision, dental, and hearing. MA plans are limited to a specific region (except for emergency care which Medicare covers nationally) and to a preferred network of healthcare providers.

The Leon Medical Centers Health Plan offers a full range of medical services. They provide transportation to and from its seven Leon Medical Centers, six Healthy Living Centers’ classes, gyms and more. At Leon Medical Centers they are committed to providing you with personal attention at all times. Call (855) 204-6456 | TTY:711 or visit LeonMedicalCenters.com/Enroll to learn more on how to enroll today!