Welcome to the Medicare page where I provide basic information on Medicare A, B, C, and D. Learn more about the different Medicare options available to you by calling 239-355-6239 to set up either a telephone or virtual appointment.

 

 

What is Medicare Part A?

Medicare Part A is the part of Medicare that covers hospital-related care. It’s often called "hospital insurance."

What Does It Cover?

Medicare Part A helps pay for:

  1. Hospital Stays: If you’re admitted to the hospital as an inpatient.

  2. Skilled Nursing Facility Care: Short-term care in a nursing facility after a hospital stay.

  3. Hospice Care: Care for people with a terminal illness.

  4. Home Health Care: Limited care at home, like nursing or therapy, if needed.

  5. Religious Nonmedical Hospital Care: Inpatient care in certain religious facilities.

Do You Have to Pay for It?

  • Premium: Most people don’t pay a monthly premium for Part A if they (or their spouse) worked and paid Medicare taxes for at least 10 years. If not, you might have to pay.

  • Deductible: You pay a set amount ($1,676 in 2025) for each hospital stay before Medicare starts covering costs.

  • Coinsurance: If your hospital stay is longer than 60 days, you may have to pay a daily fee.

How Do You Get It?

  • If you’re already getting Social Security benefits, you’ll automatically be enrolled in Part A when you turn 65.

  • If not, you’ll need to sign up through the Social Security Administration.

Key Things to Know:

  • Part A doesn’t cover everything (like long-term care or private rooms)

In short, Medicare Part A helps pay for hospital stays and related care, and for most people, it’s free if they’ve worked long enough. But there are still some costs, like deductibles and coinsurance.

 
 

 

What is Medicare Part B?

Medicare Part B is the part of Medicare that covers medical services and preventive care. It’s often called "medical insurance."

What Does It Cover?

Medicare Part B helps pay for:

  1. Doctor Visits: Appointments with doctors, specialists, and other healthcare providers.

  2. Preventive Services: Screenings, vaccines (like flu shots), and wellness visits to help you stay healthy.

  3. Outpatient Care: Services you get without being admitted to a hospital, like lab tests, X-rays, and surgeries.

  4. Medical Equipment: Durable items like wheelchairs, walkers, or oxygen equipment.

  5. Ambulance Services: Emergency transportation when medically necessary.

  6. Mental Health Services: Therapy, counseling, and outpatient treatment.

Do You Have to Pay for It?

  • Premium: Most people pay a monthly premium for Part B ($185.00 for 2025), but it can be higher if your income is above a certain level).

  • Deductible: You pay a yearly deductible ($257 in 2025) before Medicare starts covering costs.

  • Coinsurance: After the deductible, you typically pay 20% of the cost for most services.

How Do You Get It?

  • If you’re already getting Social Security benefits, you’ll automatically be enrolled in Part B when you turn 65.

  • If not, you’ll need to sign up during your Initial Enrollment Period (3 months before, during, and 3 months after your 65th birthday).

Key Things to Know:

     In short, Medicare Part B helps pay for doctor visits, preventive care, and outpatient services. It has a monthly premium, and a  yearly deductible, and typically requires you to pay 20% of the cost for most services.

 
 
 

What is Medigap?

Medigap (also called Medicare Supplement Insurance) is extra insurance you can buy to help pay for costs that Original Medicare (Part A and Part B) doesn’t cover, like deductibles, coinsurance, and copayments.

How Does It Work?

  1. You Must Have Original Medicare: To get a Medigap plan, you need to be enrolled in Medicare Part A and Part B.

  2. Pays After Medicare: Medigap plans work alongside Medicare. Medicare pays its share first, and then your Medigap plan pays some or all of the remaining costs.

  3. Covers Out-of-Pocket Costs: Medigap helps with things like:

    • Medicare Part A and Part B deductibles.

    • Coinsurance or copayments for hospital stays, doctor visits, and other services.

    • Emergency care when traveling outside the U.S.

What Does It Not Cover?

Medigap plans do not cover:

  • Prescription drugs (you’ll need Part D for that).

  • Long-term care, dental, vision, or hearing aids.

Types of Medigap Plans

There are 10 standardized Medigap plans (labeled A, B, C, D, F, G, K, L, M, and N). Each plan offers different levels of coverage, but the benefits for each plan letter are the same no matter which insurance company you buy from. For example:

  • Plan F and Plan G are popular because they cover most out-of-pocket costs.

  • Plan N is cheaper but requires small copays for some services.

Costs

  • Monthly Premium: You pay a monthly premium for your Medigap plan, on top of your Medicare Part B premium.

  • No Networks: Medigap plans let you see any doctor or go to any hospital that accepts Medicare.

When to Enroll

The best time to buy a Medigap plan is during your 6-month Medigap Open Enrollment Period, which starts when you’re 65 or older and enrolled in Medicare Part B. During this time:

  • Insurance companies can’t deny you coverage or charge you more because of pre-existing conditions.

In Short:

Medigap plans help pay for costs that Original Medicare doesn’t cover, like deductibles and coinsurance. You need Part A and Part B to enroll, and it’s best to sign up during your Open Enrollment Period to avoid higher costs or denial of coverage.

 

 

What is Medicare Part D?

Medicare Part D is the part of Medicare that helps pay for prescription drugs. It’s optional, but it’s a good idea to enroll if you take medications regularly.

How Does It Work?

  1. You Pay a Premium: You pay a monthly fee for your Part D plan (costs vary by plan).

  2. You Pay a Deductible: Some plans have a yearly deductible (up to $505 in 2023) before coverage starts.

  3. You Pay Copays or Coinsurance: After the deductible, you pay a portion of the cost for each prescription (e.g., 10forgenericdrugs,40 for brand-name drugs).

  4. Coverage Gap (“Donut Hole”): If your drug costs reach a certain limit ($4,660 in 2023), you enter the coverage gap, where you pay more out-of-pocket until you reach the catastrophic coverage limit.

  5. Catastrophic Coverage: Once you’ve spent a certain amount out-of-pocket ($7,400 in 2023), you pay only a small copay or coinsurance for the rest of the year.

What Does It Cover?

Part D covers most prescription drugs, but each plan has a formulary (a list of covered drugs). Plans must cover at least two drugs in each category, but they can choose which specific drugs to include.

How to Get It?

  1. Stand-Alone Part D Plan: If you have Original Medicare (Part A and Part B), you can add a Part D plan from a private insurance company.

  2. Medicare Advantage Plan (Part C): Many Medicare Advantage plans include Part D coverage.

When to Enroll?

  • Initial Enrollment Period: When you first become eligible for Medicare (3 months before, during, and 3 months after your 65th birthday).

  • Annual Enrollment Period: October 15 to December 7 each year (to join, switch, or drop a Part D plan).

  • Special Enrollment Period: If you qualify (e.g., losing other drug coverage).

Key Things to Know:

  • If you don’t enroll in Part D when you’re first eligible and don’t have other drug coverage, you may pay a late enrollment penalty.

  • Part D plans vary in cost, coverage, and the drugs they include, so compare plans to find the best one for you.

In Short:

Medicare Part D helps pay for prescription drugs. You pay a monthly premium, a deductible, and copays or coinsurance for your medications. It’s optional, but enrolling when you’re first eligible can help you avoid penalties.

 
 

 

 

What is Medicare Part C?

Medicare Part C is also called Medicare Advantage. It’s an alternative to Original Medicare (Part A and Part B) and is offered by private insurance companies approved by Medicare.

How Does It Work?

  1. Bundles Coverage: Medicare Advantage plans combine Part A (hospital insurance), Part B (medical insurance), and usually Part D (prescription drug coverage) into one plan.

  2. Extra Benefits: Many plans also include extra benefits like dental, vision, hearing, and fitness programs.

  3. Networks: Most plans have networks of doctors and hospitals you must use to get the lowest costs (like HMOs or PPOs).

What Does It Cover?

Medicare Advantage plans cover everything Original Medicare covers, plus:

  • Prescription drugs (if the plan includes Part D).

  • Extra benefits like dental, vision, hearing, and wellness programs.

Costs

  • Monthly Premium: Some plans have a $0 premium, but you still pay your Medicare Part B premium.

  • Deductibles, Copays, and Coinsurance: Costs vary by plan, but there are limits on how much you pay out-of-pocket each year ($8,300 in 2023 for in-network services).

How to Get It?

  • You must be enrolled in Medicare Part A and Part B to join a Medicare Advantage plan.

  • You can sign up during:

    • Initial Enrollment Period: When you first become eligible for Medicare.

    • Annual Enrollment Period: October 15 to December 7 each year (to join, switch, or drop a plan).

    • Special Enrollment Period: If you qualify (e.g., moving out of your plan’s service area).

Key Things to Know:

  • Medicare Advantage plans often have networks, so check if your doctors and hospitals are included.

  • Plans can change their costs and benefits each year, so review your plan annually during the Annual Enrollment Period.

In Short:

Medicare Part C (Medicare Advantage) is an all-in-one alternative to Original Medicare. It bundles Part A, Part B, and usually Part D, and often includes extra benefits like dental and vision. You must have Part A and Part B to enroll, and costs vary by plan.

 
 
 
 
 

 

 

 

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