Original Medicare Program
The Original Medicare Program is made up of 4 Parts currently. But at any given time you will only be using either Part A, Part B, and Part D OR you will be using Part C. Let me break down what each of these are below:
MEDICARE PART A:
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Most of the time Part A doesn't cost you anything in terms of monthly premium as long as you have paid 40 quarters in the the Medicare system through you taxes while you were working.
If you do end up needing to use your beneifts, there is a large deductible that needs to be met before Part A starts paying benefits, but then you will be covered for the 1st 60 days after before you start to realize copays and coinsurance.
MEDICARE PART B:
Medicare Part B is outpatient medical coverage. Part B helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition.
Visits to your Primary Care Physician, Specialists, Surgeries, lab work, and preventative services are all covered under Part B. There is a monthly premium that you would be responsible for that will be withdrawn directly from your Social Security check if you are drawing Social Security. Otherwise you would need to pay the premium 3 months at a time from your checking account.
There is a once a year deductible that you would have to meet before Part B pays anything, then it is a 80/20 split where you would be responsible for 20% of the costs of service.
MEDICARE PART C:
Medicare Part C is also called Medicare Advantage (MA or MAPD). It’s an alternative to Original Medicare. Medicare Advantage may include prescription drug coverage, along with other extra benefits. It is offered through private insurance companies, so you don’t enroll in it at the Social Security office or website. These are usually network plans such as HMO's and PPO's with copayments and coinsurance found all throughout the plan based on services rendered. If you have an MA plan then this becomes your Primary Insurance and Original Medicare gets set aside but you will still need to continue paying your Part B premiums.
MEDICARE PART D:
Medicare Part D is your prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare and it is mandatory that you have credible drug coverage when you join Original Medicare or if you choose a Medicare Advantage plan.
To learn more about the options of having Original Medicare with a Supplement and Drug Plan OR choosing a Medicare Advantage plan, please click one of the buttons below. You can also always press the "Click to Call" button above to reach us today!
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General disclaimers
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area.
Please contact Medicare.gov or 1–800–MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week or your local State Health Insurance Program to get information on all of your options.
Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.
The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section.
This information is not a complete description of benefits. Call 1-956-342-9469 (TTY: 711) for more information.
Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Every year, Medicare evaluates plans based on a 5-star rating system.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations.
Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year.
Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary.
For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday.
TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office.
You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.