Medicare can feel complicated when you’re first getting started. Shields & Associates Insurance Agency helps make Medicare easier to understand by explaining your options in plain English so you can make an informed decision about your healthcare coverage.

Whether you’re approaching age 65, already enrolled in Medicare, helping a family member, or reviewing your current coverage, understanding the basics is a great place to start.

What Is Medicare?

Medicare is the federal health insurance program primarily for people age 65 and older, as well as certain younger people who qualify because of a disability or specific medical conditions.

Medicare is divided into different parts, and each part helps cover different healthcare expenses.

Medicare Part A – Hospital Insurance

Medicare Part A generally helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home health services.

Many people qualify for premium-free Part A based on their work history or their spouse’s work history.

Medicare Part B – Medical Insurance

Medicare Part B generally helps cover medically necessary services such as doctor visits, outpatient care, preventive services, durable medical equipment, and certain other medical services.

Most Medicare beneficiaries pay a monthly premium for Part B.

Together, Medicare Parts A and B are commonly known as Original Medicare.

What Is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare.

Medicare Advantage plans may include additional benefits and services beyond what Original Medicare covers. Many plans also include Medicare Part D prescription drug coverage.

Plans, premiums, provider networks, benefits, and out-of-pocket costs can vary depending on the insurance company and where you live.

What Is Medicare Part D?

Medicare Part D helps cover the cost of prescription medications.

You can receive Part D coverage through a stand-alone Medicare Prescription Drug Plan or through many Medicare Advantage plans that include prescription drug coverage.

Each plan has its own list of covered medications, known as a formulary, as well as its own costs and pharmacy network.

What Is Medicare Supplement Insurance?

Medicare Supplement Insurance, also known as Medigap, works alongside Original Medicare and can help pay certain out-of-pocket costs that Original Medicare doesn’t pay.

Medicare Supplement plans are different from Medicare Advantage plans. With a Medicare Supplement policy, you remain enrolled in Original Medicare and may also purchase a separate Part D prescription drug plan.

When Can I Enroll in Medicare?

For many people, the Initial Enrollment Period begins three months before the month they turn 65, includes their birthday month, and continues for three months afterward.

However, Medicare enrollment rules can vary depending on your circumstances. If you continue working past 65 and have qualifying employer coverage, for example, different enrollment rules may apply.

Understanding when to enroll is important because delaying certain parts of Medicare without qualifying coverage could result in late-enrollment penalties or gaps in coverage.

Which Medicare Option Is Right for Me?

There isn’t one Medicare option that’s right for everyone.

When comparing your choices, consider factors such as:

• Your doctors and healthcare providers
• Prescription medications
• Preferred hospitals
• Monthly premiums
• Deductibles and copayments
• Expected healthcare needs
• Provider networks
• Prescription drug coverage
• Travel and lifestyle
• Maximum out-of-pocket costs

Understanding these differences can help you choose coverage based on your individual needs rather than simply choosing a plan based on its advertised benefits.

Already on Medicare?

Your Medicare coverage deserves regular review.

Medicare Advantage and Part D plans can change their premiums, benefits, prescription formularies, pharmacy networks, provider networks, and cost-sharing from one year to the next.

Reviewing your coverage can help you determine whether your current plan continues to meet your healthcare and prescription needs.

Medicare Help in Plain English

At Shields & Associates Insurance Agency, our goal is to make Medicare easier to understand.

We can help you learn about Original Medicare, Medicare Advantage, Medicare Supplement Insurance, and Medicare Part D prescription drug coverage and compare available options based on your individual needs.

There is no additional cost to you for working with a licensed insurance agent.

Have Medicare questions or need help reviewing your options?

Call Shields & Associates Insurance Agency at 402-545-8954 or get started below.