Get to know Medicare

What is Medicare?

It’s the federal health insurance program here in the U.S.
It is for people aged 65 or older.
It is for some people under age 65 who have a disability.
You must be a U.S. citizen or lawfully living in the U.S.
It can be called Original Medicare, too.

What are the Parts of Medicare?

Medicare Part A is hospital insurance It covers:

A hospital stay
A skilled nursing facility stay
Hospice care (comfort care for someone at the end stage of an incurable illness)
Home health care

Medicare Part B is medical insurance. It covers:

Care from doctors and other providers (like a physician’s assistant)
Outpatient care
Medical supplies
Wheelchairs, walkers, and hospital beds
Many preventive services (for example, a diabetes screening and a yearly flu shot)

Medicare Part C is hospital and medical insurance rolled into one. It’s usually called Medicare Advantage. It is offered by private insurance companies like us. It covers:

Covers everything Medicare Part A and Part B cover
Can include prescription drug benefits
Offers extra benefits you don’t get with Medicare
Is an option you can choose instead of Original Medicare

Medicare Part D is prescription drug coverage. It is offered by private insurance companies. It covers:

Covers prescriptions drugs
Covers certain recommended vaccines at no cost
Covers insulins at no more than $35 for a one-month supply
Is provided through a prescription drug plan, or PDP for short

Now that you know what Medicare is, what are your choices for getting your health care? Well, you have a couple.

After enrolling in Original Medicare (Part A and Part B), you can choose to stay on Original Medicare. Or you can go with a Medicare Advantage plan. Let’s look at each choice.

If I stay on Original Medicare

Here’s what you can expect:

You may or may not have to pay the monthly Part A premium. If you or your spouse worked and paid Medicare taxes for a certain amount of time, you likely will not pay it.
You will pay the monthly Part B premium. This amount changes each year. In 2024, it is $174.70.
If you made more than an amount set by Medicare, you may have to pay an extra amount. This is called the Income Related Monthly Adjustment Amount. (Or IRMAA for short.) This extra amount is added to your monthly Part B premium.
You will need to have prescription drug coverage. Original Medicare does not cover this. You’ll need to enroll in a prescription drug plan (PDP) to get these benefits. You will likely have to pay a monthly premium for it.

Note! If you go without prescription drug coverage for more than 63 days in a row after you become eligible for Medicare, you may have to pay a late enrollment penalty. This would be added to your monthly premium.

Original Medicare generally covers 80% of your covered healthcare costs. You have to pay the rest out of your own pocket. You can buy more insurance to cover this 20%. It’s called a Medicare Supplement plan. It’s sometimes called Medigap. This will have a monthly premium you will have to pay, too.
You can see any provider who accepts Medicare
You do not have to choose a primary care provider (PCP)
You will not have to get a referral to see a specialist

If I choose a Medicare Advantage plan

Here’s what you can expect:

A Medicare Advantage plan combines Part A (hospital) and Part B (medical) services into an all-in-one plan. This plan may or may not have a monthly premium.
The plan can include prescription drug benefits
The plan may offer extra benefits that Original Medicare does not cover. Things like:
- Dental checkups, cleanings, and fillings
- Eyewear allowances
- Over-the-counter (OTC) items
- A fitness membership
- And more
You will have to choose a plan in your area
This plan will be offered by a private insurance company
All Medicare Advantage plans must be approved by Medicare. And they must follow all of Medicare’s rules.
Depending on the plan you choose, you will need to get your care from a provider in the plan’s network of providers, hospitals, and facilities. Some plans may have an out-of-network benefit. This means you can see a provider not in the plan’s network. This usually will cost you more than seeing a network provider.

There is so much to think about when choosing health care. What should I do?

We know this is a big decision. Before you decide, think about the following.

We know this is a big decision. Before you decide, think about the following.
Look at your budget. How much can you afford to spend each month on premiums and your care?
If you decide to go with a Medicare Advantage plan, look for one in your area.
Check the plan’s documents to see:
- Who is and isn’t in their provider network.
- The prescription drugs they cover. How much do they cost.
- If a referral is needed to get care.
- Or, if there are prior authorization requirements.
- What your out-of-pocket costs may be.
- What extra benefits you may get.
Talk with the Senior Health Insurance Information Program here in Arkansas. It’s a free program that helps people with Medicare. They can help you understand all your options and answer your questions. Call them at 800-224-6330 . Or visit www.shiipar.com .
Give us a call. Visit our Customer Service page our phone number and hours. We will be happy to help.
Talk with a local health insurance broker or agent.