Lots of Medicare Questions From Employers and Employees This Year

…Here are the ABC’s (and Part D)

For whatever reason – aging workforce, increasing costs, heightened awareness because of ACA – we’re getting lots and lots of questions from clients and their employees about Medicare this year. Way more than in years past. The vast majority of questions are about the basics.

And, it’s easy to get confused about what’s what. So thought it might be helpful to put together a cheat sheet of sorts about the basics. Here’s a quick summary of the ABC’s (and Part D’s)…

Traditional or Original Medicare. Parts A and B make up Original Medicare which is run by the federal government. Part A covers in-patient care (eg. Hospitals). Part B covers out-patient care (eg. Doctors visits). Medicare doesn’t pay for everything.  Individuals have out of pocket costs in the form of deductibles, co-pays, and co-insurance. Plus, Part B requires premium payments (@ 105 bucks a month this year for most people). Medicare Part D (more on that later) and Medicare Supplemental (more on that later, too) can be added to Original Medicare.

Medicare Advantage (also known as Part C). This takes the place of Original Medicare and serves as an alternative. It’s offered by private insurance companies and approved by Medicare. At a minimum, these plans must include the same benefits as Original Medicare (ie. Parts A&B).  Many include more benefits. They cannot, however, offer less coverage than the sum of Parts A & B.

Medicare Part DOptional Prescription drug coverage offered through private insurance companies. This can be added to original Medicare or it may be included as part of a Medicare Advantage plan.

Medicare Supplemental (aka, Medigap). These are private insurance plans that can be purchased and added to Original Medicare to help cover out-of-pocket costs such as deductibles, co-insurance, co-pays and other things that Medicare might not cover.  These plans can only be coupled with Original Medicare and cannot be combined with a Medicare Advantage Plan.

So, quick summary.

Original Medicare = Parts A & B. Federal government provides. Part D and Supplemental can be added.

Medicare Part C = Medicare Advantage. Private carrier offers as alternative. Takes the place of Original Medicare and must at a minimum provide the same coverage. Can include Part D. Cannot be combined with a Supplemental.

Part D = Prescription Drug Coverage.  Offered through private carrier. Can be added to Original Medicare or included with Medicare Advantage.

Medigap = Supplemental.  Can be added to original Medicare. Cannot be combined with Mediccare Advantage

For more comprehensive info check out Medicare and You 2015



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