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Medicare Basics

Let's take a look at everything that comes together to make up what we know as Medicare.

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What is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older

  • Certain younger people with disabilities

  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

What are the parts of Medicare?

The different parts of Medicare help cover specific services:

  • Medicare Part A (Hospital Insurance)
    Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  • Medicare Part B (Medical Insurance)
    Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

  • Medicare Part D (prescription drug coverage)
    Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

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What is the cost of Medicare?

Part A & Part B Premiums

Most people don’t pay a monthly premium for Part A.

  • You usually don't pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called "premium-free Part A."

  • If you don't qualify for premium-free Part A, you can buy Part A.

Everyone pays a monthly premium for Part B.

  • Most people will pay the standard Part B premium amount.

  • The standard Part B premium amount in 2022 is $170.10.

  • If your income is above a certain amount, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

How does Medicare work?

Original Medicare is coverage managed by the federal government. Generally, there's a cost for each service. Here are the general rules for how it works:

  • In most cases you can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients.

  • With a few exceptions, most prescriptions aren't covered in Original Medicare. You can add drug coverage by joining a Medicare Drug Plan (Part D).

  • You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There's no yearly limit for what you pay out-of-pocket.

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Set up an appointment with us so that we can help you navigate through your Medicare Journey!

Medicare Insurance Options

Once you are enrolled in Medicare you have a number of choices to make on how you want to access your care. At Raven & Wolf Benefits, we believe that each of our clients has unique needs. We believe that it is our mission to help each client find the best coverage options to meet their needs.

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Medicare Advantage Plans (Part C)

Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.

  • These “bundled” plans include Part A, Part B, and usually, Part D.

  • In most cases, you’ll need to use doctors who are in the plan’s network.

  • Plans may have lower out-of-pocket costs than Original Medicare.

  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

Medicare Supplement Plans (Medigap)

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies.

  • Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. 

  • A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

    • Copayments

    • Coinsurance

    • Deductibles

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Prescription Drug Plans (Part D)

Prescription drug coverage is not included with Original Medicare or Medigap plans. If you decide to go with either of these options it is recommended that you also enroll in a standalone prescription drug plan.  This helps you to avoid penalties for late enrollment and also helps you to be sure that your prescriptions will be covered.

Set up and appointment with us so that we can help you navigate through your Medicare Journey!

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