Medicare 101

Published by Hemati on

By Tristan Labelle, Archangel Brokers

Sometimes Medicare can be a confusing mess. Between trying to figure out what everything means (In plain English) vs. trying to find the right plan, It can be extremely frustrating. If this sounds familiar, then you’re at the right place. Let’s talk about the individual parts. We’re going to keep things pretty simple and palatable in this post. If you want further or more in depth explanations, then read Medicare and You 2021 from The Center of Medicare and Medicaid Services. There you will find the most in-depth information about Medicare.

Imagine that we’re going to be building a house. First, you need the foundation, walls and ceiling. Second we’re going to need some basic appliances in the house like a washer and dryer. Third were going to need to furnish the home with all the good stuff, couches, tables etc. Fourth we need to have A/C because it’s hot in Florida and because they mandate A/C in Miami.

PART A

This is the part that is the least important in your journey. Part A is hospital coverage. This is the walls and the ceiling part of your Medicare. This is the foundation. Without part A, you can’t do anything else.

Part A in a nutshell is the basic coverage you use when you get admitted into the hospital. This is the ”Free to have, not free to use.” This is the annoying part that we’re all paying out our pay checks while were working. If you’re working now and turning 65 and plan on staying with your work coverage, Medicare will send you the part A automatically.

PART B

Yay! You’re almost Medicare ready! This is when Medicare is almost fully activated. Your part B in summary is the 80%/20% rule. Medicare covers 80% and you pay 20%. Your part B is like your appliances in the house, you need to have basic appliances in your house to function properly. Your part B premium is based on your income. The more you make, the more you pay. It starts at $148.50 per month and goes up from there. There is only 2 ways to eliminate that. 1. you have Medicaid benefits or 2. you pick a plan that compensates for that (Traditionally they have more co-pays or costs associated with the plan so most of the time, it is better not to have a give-back plan)

A and B Summary

Great!! You are inching towards your Medicare goal! So in review. Part A and B are the necessities to have 80% covered. Now let talk about the last two parts.

Part D

This is the A/C in your house. It is a necessity in the state of Florida to have working A/C in a home to make it livable. Just like it is mandatory to have a part D plan or YOU WILL GET PENALIZED. Part D is your drug plan Part D = Drugs. We will talk more about this in the next section but the basics is depending on the plan you choose, it may be included or you will need to pay for a plan solo.

Part C

Ahh here we are, the fun part. The furniture. This is the customizable part of your Medicare plan. What were going to do here is divide this part into 3 sections. The first with be defining MediGap plans, the second will be talking about the 2 different part C plans. All 3 types will cover the remaining 20% that Medicare part A and B don’t cover for you. You just need to choose which type of plan works best for you. Just like some people like to have a dining room table and some people would rather use the same space for a bar area. The choice is up to you.

1. MediGap plans

These are the Mercedes plans. These are the freedom plans where you are not attached to any network. Awesome. I know. MediGap plans cover the 20% and you can go anywhere that accepts Medicare as an insurance (Which is most of them). That is the pro, lets talk about cons. The negative with these types of plans is you’ll have to pay for a seperate drug plan (Part D) and they do not offer any extra benefits. You also will pay an additional monthly premium aside from your part B monthly premium. These plans can range in pricing from $100 per month to $400 per month.

2. Part C HMO

These are the company plans. You see all the advertisments for these plans everywhere. Your HMO plans are the most benefit giving plans that are out to the market. HMO plans are great because you get pretty much everything for free in Miami-Dade/Broward. Virtually no co-pays, no deductibles or out of pocket for most things. The negative here is you’re going to need referrals to see specialists.

3. Part C PPO

These are the most familiar plans to most people. Most employer plans are PPO’s. They are really a good mix between your HMO and your MediGap plans. They give you some benefits and limited freedom where you dont need referrals, just as long as you stay in-network. The negative here is there will be more co-pays and other random fees for services.

Congratulations!!!! You have done it! These are the 4 parts of Medicare in about 10 minutes. Now all you need to do is book an appointment with one of our knowledgable reps and in no time you’ll be prepared for everything.

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Categories: Insurance

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