Getting a grasp on medicare

If you're new to Medicare — and even if you're not so new — grasping the basics can be difficult. There are unfamiliar terms to learn and special periods for enrolling. There are also lots of coverage options, so it's important to understand the fundamentals before making any decisions. To get you started, here are some common terms and what they mean.

Original Medicare

Original Medicare is the standard medical coverage from the U.S. government that most people are eligible for at age 65. It has two parts: Part A and Part B.

• Part A covers hospitalization. You're automatically enrolled in Part A at 65 if you're receiving Social Security benefits. If not, you can sign up during the month you turn 65 or during the three months before or after your birthday month. Most people do not have to pay a fee to receive Part A benefits.
• Part B covers medical services, such as doctor's visits, tests and outpatient services. If you receive Social Security benefits, you're automatically enrolled in Part B at 65. If not, you can sign up during or around the month of your 65th birthday, just like with Part A. There is a monthly premium for Part B. If you don't want it, you may opt out.

Original Medicare typically pays 80% of your health care costs, and you pay 20% after you've met any deductibles. Original Medicare doesn't cover prescription drugs.

Medicare Advantage plans

Medicare Advantage plans are an alternative to Original Medicare. Private insurers that are contracted with the federal government to provide Medicare, like Priority Health, offer these plans. When you belong to a Medicare Advantage plan, you're still in the Medicare program. You'll continue to get Part A and Part B, plus extra benefits. Many Medicare Advantage plans also include prescription drug coverage (Part D). To enroll in a Medicare Advantage plan you need to have Parts A and B, and you must continue to pay your Part B monthly premium.

Medigap (Medicare Supplement)

Medigap plans help pay for some of your out-of-pocket costs that Original Medicare doesn't cover. You purchase a Medigap plan from a private insurer. Medigap plans are standardized nationwide — Plan A from one company will give you the same benefits as Plan A from another company. The only difference between the plans is their monthly premiums and the quality of the customer service. You must have Part A and Part B to purchase a Medigap policy. Prescription drugs aren't covered.

Prescription drug coverage (Part D) plans

Part D only covers prescription drugs and is separate from Original Medicare. Part D is only available through private insurers, and you need to have Medicare Part A and/or Part B to purchase it. You can receive Part D coverage through many Medicare Advantage plans. Or you can choose a stand-alone plan to complement Original Medicare, a Medigap plan or a Medicare Advantage plan that doesn't include drug coverage. Did you know? Priority Health Medicare members are allowed one annual comprehensive physical exam. (A copay may apply.) Your doctor will review your health conditions, update your medicines, order labs and rule out any changes in your health. A physical is not the same as a routine checkup for diabetes or other health conditions.

Topics: Medicare