Medicare

Medicare is the federal government healthcare program that subsidizes healthcare services for adults over 65. The plan also covers people younger than 65 who qualify through disability and those with certain diseases, including end-stage renal disease and amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). To qualify for Medicare, an individual must be either a U.S. citizen or a legal permanent resident that has been in the country for at least five continuous years.

Medicare is separated into different parts that cover a variety of medical situations. While Medicare provides beneficiaries with more choices in terms of coverage and costs, it also presents complexity for the people looking to enroll. Here is an overview of how Medicare parts.

Original Medicare & Plan F

Pros:

Covers the remaining 20% of Medicare-approved expenses under Parts A and B
Accepted by any healthcare provider nationwide that accepts Original Medicare (no networks)
No referrals required to see specialists
No deductibles, copayments, or coinsurance with standard Plan F
Guaranteed renewable as long as premiums are paid on time
You may apply to switch to another Medicare Supplement plan any time of the year (subject to underwriting)

Cons:

Monthly premiums typically range from $285 to $520 or more depending on factors like age, location, and tobacco use
Premium rates may increase annually, with average increases of 10% to 12%
Switching plans after age 65 may require medical underwriting, which could affect acceptance and pricing
Does not include prescription drug, dental, vision, or hearing coverage
Not available to individuals who became Medicare-eligible on or after January 1, 2020

Original Medicare & Plan G

Pros:

Covers the remaining 20% of Medicare-approved expenses under Parts A and B (after deductible)
Accepted by any doctor or hospital nationwide that takes Original Medicare (no networks)
No referrals required to see specialists
$240 annual Part B deductible in 2025; after that, no coinsurance or copays for covered services
You may apply to switch to another Medicare Supplement plan at any time of the year (subject to underwriting)
Guaranteed renewable for life as long as premiums are paid

Cons:

Monthly premiums typically range from $90 to $110 or more depending on factors like age, location, and tobacco use
Annual rate increases typically average 1% to 3%
Switching plans after age 65 may require medical underwriting, which could affect acceptance and pricing
Does not include coverage for prescription drugs, dental, vision, or hearing

Medicare Advantage Plans

Pros:

Combines Medicare Parts A and B, and usually includes Part D (prescription drug coverage)
Monthly premiums range from $0 to $100 depending on the plan and service area
Most plans include drug coverage
Many plans include dental, vision, and hearing benefits
Fitness benefits like SilverSneakers® are included in many plans
No medical underwriting required to enroll

Cons:

Must use in-network providers for non-emergency care (limited or no coverage outside the network)
Plans and benefits can change annually
Providers can leave the plan’s network at any time during the year
Referrals are usually required to see specialists
Copayments, coinsurance, and deductibles apply
Maximum out-of-pocket costs can be up to $8,300 for in-network services in 2025
Plans generally require a 1-year contract commitment
Prior authorization is often required for certain procedures and services

How Does Medicare Work?

Medicare is a health insurance program created by the United States federal government. While Medicare is a federal government healthcare program, private health insurance companies can and do play a significant role in providing subsidized health plan coverage.

A Medicare beneficiary can decide to receive their benefits through private health insurance companies, or you can decide to receive Part A and Part B healthcare coverage and enroll in a Medicare Prescription Drug Plan (Part D) with a private health insurance company.

Medicare Parts

To understand the essentials of Medicare, it is crucial to learn the different parts of Medicare coverage, which include:

Medicare Part A: This is a part of the Original Medicare plan that covers inpatient care and hospital stays. Medicare Part A is vital in case you have a sudden illness or unexpected injury that requires inpatient care.
Medicare Part B: Medicare Part B is the other part that makes up Original Medicare. This part includes long-term preventive care, doctor visits, medical supplies, medical tests, and X-rays. Medicare Part B covers health care visits that help you stay healthy.
Medicare Part C (Medicare Advantage): This is an all-in-one Medicare plan that combines Original Medicare and usually Medicare Part D to provide more health care options. Most Medicare Part C plans include coverage for prescription drugs, hearing aids, vision, and dental care.
Medicare Part D: This part of Medicare covers prescription drugs. Part D is offered as a standalone prescription drug plan through private insurers, with the monthly fee varying among the private insurance companies.

Part B & Part D Premiums

Where Can I Find Out More About Medicare?

If you are new to Medicare or know someone who is, and you are looking for someone who can help you make the transition easier, contact Great Nation Insurance.

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Medicare

Original Medicare & Plan F

Original Medicare & Plan G

Medicare Advantage Plans

How Does Medicare Work?

Medicare Parts

Part B & Part D Premiums

Where Can I Find Out More About Medicare?

Get Your free Quote

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