Understanding what you pay and what you receive with Medicare is crucial for making informed healthcare decisions. Here’s an overview of how Medicare works, what costs you’re responsible for, and the options available to enhance your coverage in 2024 and 2025.

Original Medicare: Part A and Part B

Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), generally covers 80% of approved healthcare expenses. You are responsible for paying the remaining 20% of costs, which may include deductibles, copayments, and coinsurance.

• Medicare Part A: Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.

• Medicare Part B: Covers outpatient services, doctor visits, preventive care, lab tests, and durable medical equipment.

If you are also enrolled in Medicaid, it may cover some or all of the 20% of costs that Medicare does not pay, significantly reducing your out-of-pocket expenses.

Prescription Drug Coverage (Part D)

Original Medicare does not cover prescription drugs. To get coverage for your medications, you’ll need to enroll in a Medicare Part D plan, which is a standalone prescription drug plan offered by private insurance companies approved by Medicare.

Medicare Advantage Plans (Part C)

Medicare Advantage (Part C) plans are an alternative to Original Medicare. Offered by private insurance companies under contract with the Centers for Medicare & Medicaid Services (CMS), these plans combine Part A and Part B benefits and often include prescription drug coverage (Part D) as well as additional services like dental, vision, and wellness programs.

• Medicare Advantage Plans replace your Original Medicare, but you’ll still need to follow the rules and enrollment procedures set by CMS.

• Plans may vary in terms of coverage and cost, so it’s important to shop around and select the plan that best fits your needs.

Medicare Supplement Insurance (Medigap)

Medigap is supplemental insurance designed to work alongside Original Medicare. It helps cover the 20% of costs that Medicare doesn’t pay, including copayments, coinsurance, and deductibles. Medigap policies are sold by private insurers and are regulated by CMS.

• Medigap only works with Original Medicare, not Medicare Advantage.

• It provides additional protection, helping you manage out-of-pocket expenses for services covered by Medicare.

Key Takeaways

• Original Medicare covers 80% of most medical costs, but you’re responsible for the remaining 20%.

• Medicare Advantage plans are an all-in-one alternative to Original Medicare and may include extra benefits like drug coverage, dental, or vision.

• Medicare Supplement (Medigap) plans help cover the gaps in Original Medicare, reducing your out-of-pocket costs.

Exploring your options and finding the best plan for your specific healthcare needs is essential. For help navigating Medicare in 2024 and 2025, contact us today! We can guide you through the process and ensure you get the best coverage for you.