Medicare Explained

Medicare Explained

Medicare is a federal insurance program that provides healthcare coverage to those eligible. The two most common Medicare plans are:

  • Medicare Part A
  • Medicare Part B

Original Medicare

Parts A and B, otherwise known as Original Medicare, offers easy enrollment and eligibility, as well as low monthly and yearly payments for continued coverage.

To qualify for one or both of these plans, you must meet at least one of the following requirements:

  • Be 65 Years Old or Older
  • Have End-Stage Renal Disease (ESRD), Lou Gehrig’s Disease, or ALS
  • Have Received Social Security Disability Benefits for at Least 24 Months

Covering the costs of Medicare includes 3 basic methods of payment: premiums, deductibles, and copayments/coinsurance. The same goes for all of the additional coverage options as well. These payments work like this:

  • Premium: A monthly payment you make to the plan based on your needs, health, and amount of coverage. 
  • Deductible: A yearly fee you must meet to maintain your coverage (not included in your premium payment).
  • Copayment/Coinsurance: Each time you use benefits from your plan, you will likely have to pay an out-of-pocket fee. This will either be a flat cost known as a copayment or a percentage of the total cost known as coinsurance.

You likely will not, however, have to pay premiums for Medicare Part A. If you have worked at least 10 years while paying Social Security taxes, you’re eligible for premium-free Part A.

Parts A and B cover basic costs such as hospitalization and various medical fees. Part A coverage is simple and includes:

  • Hospital Inpatient Care
  • Nursing Facility Care
  • Nursing Home Care
  • Hospice Care
  • Home Health Services

Part B coverage is a bit more vague. Its benefits include (but are not limited to):

  • Cardiac Rehabilitation
  • Limited Chiropractic Services
  • Ambulance Services
  • Diabetes Supplies
  • Durable Medical Equipment (DME)
  • Kidney Dialysis Services and Supplies
  • Outpatient Mental Healthcare
  • Physical Therapy

Medicare Part C

There are also 3 types of additional coverage you can add to your health insurance plan when signed up for A and B:

  • Medicare Part C (Medicare Advantage)
  • Medicare Part D
  • Medicare Supplements

Medicare Part C, or Medicare Advantage, coordinates your regular healthcare providers to lower your out-of-pocket costs with some additional benefits. 

There are five different types of plans, each of which offers different benefits, prices, and coordination methods:

  • Special Needs Plans (SNPs) 
  • Preferred Provider Organization (PPO) Plans 
  • Health Maintenance Organization (HMO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medicare Medical Savings Account (MSA) Plans

Medicare Part D

Medicare Part D provides prescription drug coverage. These plans are structured in tiers—the higher the tier, the more you will have to pay out-of-pocket.

However, it is highly recommended to add a Part D plan to your Medicare coverage if you are able and in need, because, on their own, prescriptions are incredibly expensive.

Medicare Supplements

You cannot add Part D to a Medicare Supplement plan. However, supplements cover a huge variety of other costs.

There are 10 Medigap plans on the market, including plans A, B, C, D, F, G, K, L, M, and N. Your choice of a plan depends solely on your healthcare and financial needs.

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Find the Medicare Coverage You Need with Texas Medicare Advisors

There is no one else in the great state of Texas that knows insurance like we do. With our expertise, you can be sure that you are getting the best Medicare plan and price out there. If you’d like to get started, call Texas Medicare Advisors at 512-900-3008.