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Metro Valley Insurance

"The Right Plan For A Healthier You" 

As you get closer to turning 65, you may be asking yourself “What is Medicare?” It’s a good time to get informed and start thinking about your future healthcare needs. Be prepared for what lies ahead by educating yourself now. Discover what’s covered by Medicare and what’s not and understand your options.

Understanding Medicare and How it Works

Many people find Medicare confusing, but understanding Medicare is easy once you learn some basic concepts. When you’re informed, you can make smart decisions about your healthcare. We’re here to help. Discover what the different parts to Medicare mean and how it works.

What is Medicare?

Medicare is a government-sponsored health insurance program. It’s designed to provide health insurance for people ages 65 and older and people under 65 with certain disabilities. It can also provide benefits to those under age 65 with certain disabilities and certain serious conditions.

Understanding the Different Medicare Parts

There are different types of Medicare plans, which are broken into “Parts.” Medicare Parts A, B, C and D are the most common Medicare programs.

Medicare Part A (hospital insurance)

Many Americans like you become eligible for Medicare Part A when they reach age 65. Medicare Part A does not require an additional premium.

What is Covered by Medicare Part A?

•Inpatient hospital cared

•Skilled nursing facilities following a hospital stay

•Hospice care

•Some home healthcare

Medicare Part B (medical insurance)

Medicare Part B is the segment of Medicare that helps pay for medical services and supplies not covered by Part A. Part B includes preventive services to help you maintain your health and keep illnesses from getting worse.

What is Covered by Medicare Part B?

You may elect to receive both Medicare Parts A and B through one plan that is managed via a private insurance company. This is known as Medicare Part C or Medicare Advantage.This optional coverage typically carries an additional premium and charges different out-of-pocket costs for various services and supplies. These costs are capped.

•Doctors’ and other healthcare providers’ services

•Outpatient hospital care when medically necessary

•Some other medical services and supplies not covered by Medicare Part A when medically necessary

Medicare Part C (Medicare Advantage)

You may elect to receive both Medicare Parts A and B through one plan that is managed via a private insurance company. This is known as Medicare Part C or Medicare Advantage.This optional coverage typically carries an additional premium and charges different out-of-pocket costs for various services and supplies. These costs are capped.

Medicare Part D (prescription drug coverage)

This policy can be purchased if you are enrolled in Medicare Part A, B or C. It is an optional drug plan provided by Medicare-approved private insurance companies. If you have a number of prescriptions, you may benefit from Part D, but the coverage does include an additional premium.

What is Covered by Medicare Part D

•Prescription drugs (on the Medicare formulary - the preferred list of covered drugs – which may vary by insurance company)

•Potential discounts on some prescription drugs

•Protection against higher prescription drug costs in the future

Discover Medicare Supplement Plans

Medicare does not cover all healthcare expenses. For example, if you stay in the hospital or a skilled nursing facility for an extended period of time, those costs may not be covered by your Medicare plan. In addition, there are other costs and medical expenses Medicare does not cover. This is where Medicare Supplement insurance, or Medigap, can be a good option.

What is Medicare Supplement Insurance (Medigap)

Medicare Supplement insurance (Medigap) is provided by private insurance companies to pay for healthcare costs that Medicare does not cover.

What Medicare Supplement Insurance Provides

These plans help cover costs that are not covered by Medicare, including:

•Deductibles •Copayments

•Coinsurance

•Care received while traveling outside the U.S.

Medicare Supplement Insurance Eligibility

For you to be eligible for Medicare Supplement insurance, you must:

•Be a permanent resident of and reside in the plan’s state for at least six months of each calendar year

•Be age 65 or older

•Be enrolled in both Medicare Part A and Part B

•Continue to pay your Part B premium