What is Medicare

Medicare is a health care program administered by the Social Security Administration and overseen by the Centers for Medicare and Medicaid (CMS). It is a federal program unlike Medicaid that is administered through each individual state’s Department of Health and Human Services. More than 103 million people across the U.S. rely on Medicare for their primary health insurance and is one of the more successful government programs ever established. While the program doesn’t cover all health care costs, it does provide a solid foundation to begin to mitigate non covered costs through private health insurance plans like Medigap and Medicare Advantage plans.

Benefits of Original Medicare

There is a difference between Medicare and Original Medicare. While Medicare refers to the entire Medicare program, Original Medicare refers to specific components of the program. Namely, Part A and Part B of Medicare. Part A is the component of Medicare that provides hospital insurance, while Part B covers medical insurance. Together, the two parts

make up Original Medicare, which is the most popular Medicare option. It is important to understand without Original Medicare you cannot participate with a Medicare Supplement plan or a Medicare Advantage plan.

Part A coverage helps cover hospital stays by paying a deductible of $1484 for each benefit period up to 60 days. If you were in the hospital for pneumonia for 1 week and 2 months later in the hospital for a bladder infection you would have two separate benefit periods. Medicare would charge you two separate deductibles. If your stay in the hospital is over 60 days you must pay a copayment of $371 per day from day 61 – day 90 and if the stay lasts longer than 90 days, your per day hospital charges go up to $742 per day for the next 60 days.

Other care like skilled nursing Medicare Part A hospital covers the first 20 days at no charge followed by the next 80 days at $185.50 per day. Hospice and in-home care are covered through Medicare at no additional charges.

Medicare Part B handles medical costs and Medicare Part B Drugs. The coverage begins once you have met your annual Part B deductible of $203 in 2021. Since Part B is the medical insurance component of the program, it covers medically necessary services and preventive health. This includes major necessities like check-ups, outpatient surgeries, ambulance services, durable medical equipment, diagnostic testing, procedures. and routine exams and more.

Medicare Advantage

Original Medicare is only one option that Medicare beneficiaries can choose from and one that has large deductibles, copays, and co-insurance with no maximum out of pocket charges. The Part C plans, or Medicare Advantage plans cover all the same benefits as Original Medicare. These plans are alternative Medicare plans that must meet strict requirements to be approved for sale by private insurance companies. The plans are not standardized like Original Medicare or Medigap plans so prospects have far more options as to what types of coverage they can access.

Medicare Advantage plans replace Original Medicare with a requirement that a member must maintain and keep their Original Medicare active. Medicare Advantage plans are known for low premiums or zero premium plans. These plans have copays and coinsurance with possible deductibles depending upon the plan offering. Based on the benefits of the plan will determine what your portion of hospital and medical costs will be. Often you will have a Medicare Drug plan built into the coverage so no additional expense will be incurred.

Medicare Advantage plans offer many customary benefits that are not covered by Original Medicare giving you a more well-rounded healthcare experience. For example, some advantage plans offer dental, vision, and hearing coverage with gym memberships and over the counter health related items. Some plans include transportation to doctor visits as well. Which benefits are offered depends on the plan you choose and where you are located. Part C plans are county specific so not all plans are offered in all areas. The larger the Medicare population the more plans that are normally offered as more companies come to the area to compete for the business. To get help comparing Medicare Advantage plans, you may wish to reach out to an insurance professional. We have been working with Medicare advantage plans since 2006. 

Choosing Your Coverage

You are not required to enroll in Medicare, but it is often the wisest choice to do. An exception may be if you have a current employer coverage that you like and is not overly expensive. You can delay your Part B Medicare enrollment without incurring late enrollment fees when the coverage is deemed creditable. To learn more, we are always available and would love to help assist you. Just reach out to Larry Klein 515-664-7078 now to get started with a free consultation. 


Contact us today!

For more information about your coverage options in Iowa and across the Nation, reach out to Larry Klein of Iowa Medicare Group today!