Understanding Medicare Basics

Original Medicare

On July 30^th, 1965, President Lyndon B. Johnson signed into law the Social Security Act Amendments, popularly known as the Medicare bill. Original Medicare is the US health insurance program for people who are 65 or older, certain younger people with disabilities as well as people with End-Stage Renal Disease (ESRD). Original Medicare provides the needed benefits for older Americans including hospital insurance (Part A) and medical insurance (Part B). To receive the covered benefits from Part A or Part B, the hospital, medical provider, procedure or treatment, and/or doctor must accept and be approved by Medicare.

​Part D Prescription Drug Coverage

Over the years there have been many amendments and adjustments to what is known as Medicare. One such adjustment was the Medicare Modernization Act of 2003 and the creation of Medicare Part D, also called the Medicare prescription drug benefit. Medicare Part D is an optional program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums. Part D is considered an “optional” program, however it is encouraged to enroll in Part D along with Original Medicare to extend the benefit coverage.

​Medicare Supplement & Part D

Medicare Supplement Insurance, also known as Medigap, helps fill in the “gaps” of Original Medicare. Although Original Medicare covers much of the costs for health care services, it does not cover all charges and the individual must cover the remaining out of pocket. This is where Medicare Supplemental Insurance comes in and covers the remaining costs.

Medigap covers the leftover costs from Medicare, such as copayments, coinsurance and deductibles. Some Medicare Supplement policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the country. It is important to discuss all aspects of coverage with a qualified Medicare insurance agent. With Medicare Supplement Insurance it is strongly encouraged to also enroll in a separate Part D drug plan to cover the cost of prescription drugs.

​Medicare Advantage (Includes Part D)

Medicare Advantage (Part C) Plans are another way to get your Medicare Part A, Part B and in many cases includes Part D drug coverage. Medicare Advantage is offered by private insurance companies approved by Medicare. The types of advantage plans differ by provider network but include; Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans, Private Fee-for-Service (PFFS) Plans, Special Needs Plans (SNPs), as well as the less common HMO Point of Service (HMOPOS) Plans and Medicare Medical Savings Account (MSA) Plan.¹

Medicare Part C Plans offer coverage for things Original Medicare does not. These items include vision, dental and hearing coverage. In addition, some Advantage Plans include prescription drug coverage commonly found in Part D programs. Some offer even more services such as fitness programs (gym memberships or discounts), as well as transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness.²

​Original Medicare & VA (Covers Part D)

For veterans, it is strongly encouraged to enroll in Original Medicare even though the veteran may already have health benefits through the U.S. Department of Veterans Affairs (VA). VA coverage pays for medical services if you go to a VA hospital or doctor. If you need to go elsewhere, you’ll probably end up having to pay the full cost yourself, even in emergencies. With Medicare, you’re covered if you need to go to a non-VA provider. This is an especially important point to consider if you live some distance from the nearest VA facility.³ With regards to prescription drug coverage the VA explains “Enrollment in the VA health care system provides a prescription drug benefit that has been determined to be as good as the benefit provided under a Medicare prescription drug plan. As a result VA enrollment provides ‘creditable coverage’ for Medicare Part D purposes.”⁴ As a result, this covers your Part D necessity and no additional Part D plan is needed.

​Medicare Advantage & VA (Covers Part D)

As with the above section you can extend your VA benefits even further with a Medicare Advantage Plan in addition to VA health coverage. Some Medicare Advantage Insurance Providers have specific plans that are offered only to veterans and provide added perks and benefits. Some of these added benefits include visits, procedures or items that are outside the VA health system. And as with most Medicare Advantage Plans routine dental, hearing, and vision benefits would be covered when Original Medicare would not. An additional perk is monthly credits applied to your Medicare Part B premium. As an example of this type of Medicare Advantage Plan, the provider offers $50 off Part B Premiums every month.

​Which Medicare Plan is Right For Me?

Getting the right coverage and benefits is extremely important to be able to enjoy life to its fullest. Be sure to speak with an experienced and qualified Medicare Agent to coordinate the proper plan for you! At CSG Medicare Pros our Agents are experienced and qualified Licensed Medicare Brokers specializing in Medicare Health Insurance providing Medicare (parts A and B), Medicare Supplemental Insurance, Medicare Advantage (Part C) and Medicare Prescription (Part D) plans. We serve Medicare recipients in every county in Arizona including in the cities of Phoenix, Mesa, Tempe, Chandler, Apache Junction, Gilbert, Tucson, Kingman, Bullhead City, Prescott, Flagstaff, Yuma, Sierra Vista and more. CSG Medicare Insurance Agents are independent, licensed and appointed with multiple insurance carriers to give you a wide variety of choice. For more information, call (480) 635-4050 or (928) 263-8500.