A guide to Medicare coverage and options for filling the gaps
Understanding Medicare
What is Medicare?
Medicare is a federal health insurance program for people...
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Ages 65 and older​
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Under age 65 with certain disabilities
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Any age with end-stage renal disease or kidney failure
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Original Medicare provides an array of benefits, however it leaves its enrollees with many coverage gaps. Although deductibles, coinsurance and copays associated with Medicare are competitive, there are no out-of-pocket caps, which could leave you responsible for paying thousands of dollars for medical treatment.
The Big Question
You may be wondering "Do I need to enroll in Medicare?" and for most people turning 65, the answer is yes.
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However, there are many situational variants. Before we proceed with simplifying your understanding of Medicare, it's important that we determine when you need to take action.
Click the button to be redirected to Medicare's eligibility tool, where you can answer a few short questions and estimate your deadline to enroll into Medicare without any future re-occurring penalties.
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Medicare
Part A
Hospital Care
Skilled Nursing Care
Hospice Care
Blood Services
Large out-of-pocket costs without limitation
$0 premiums for individuals with 40 credits, or roughly 10 years work history, paid by FICA taxes
Inpatient Hospitalization
You Pay:
Part A Hospital deductible
Days 1-60
(may be paid several times in a 1 year span)
Part A Hospital Daily Co-Pay
Days 61-90
Part A Hospital Daily Co-Pay
Days 91-150
(Lifetime reserve days, may only be used once)
$1,600.00
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$400.00
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$800.00
Skilled Nursing Care
You Pay:
Days 1-20
(Requirements must be met)
Days 21-100
Days 100+
(Considered Long-Term Care, not covered by Medicare)
$0
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$200.00
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All Costs
Hospice Care
You Pay
Certified Terminal
$0
Respite Care
5%
Blood
You Pay
Pints 1-3
All Costs
Pints 3+
$0
Medicare
Part B
helps cover costs associated with
outpatient care
(Ex. Doctors visit, diagnostic testing)
No yearly patient out-of-pocket cost limit
Standard premium of $164.90. This amount may increase for those in higher income brackets
Physician, Outpatient Care & Labs
Part B Deductible
Annual (2022)
$226
Medical Expenses
Coinsurance
20%
Excess Charges, up to 15% of Medicare allowable amount
Coinsurance
All Costs
Covering the Gaps of Original Medicare
Let's explore the 2 ways to cover Medicare coverage gaps
Medicare Supplement
Also known as Medigap
Medicare Supplement plans offer reliability and security as they can cover everything original Medicare doesn't.
Medicare Advantage
Also known as Part C
Medicare Advantage plans can offer a more cost-effective solution for gap coverage. They parallel that of a typical HMO or PPO plan.
Lets Compare...
Medicare Supplement
Medicare Advantage
Do I have freedom to choose my providers/hospitals?
Yes
No
Do I need referrals to see a specialist?
Can my plan benefits change?
No
No
Yes, if HMO
Yes
Is coverage guaranteed renewable if premiums are paid?
Yes
No
Does it include prescription drug coverage?
No, plan purchased separate
Usually, Yes
Will I be covered if I travel inside or outside of the U.S.?
In an emergency, will my out-of-pocket costs be predictable?
No
Yes
Yes
No
Will there be an additional premium?
Yes
No, typically