Common Medicare Questions
If you would rather speak with somebody, click the button below from your mobile device to call us.
What is Medicare?
Medicare is the federal health insurance program for:
People who are 65 or older
Certain younger people with disabilities
People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant sometimes called ESRD)
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part D Prescription Drug Plans
Part D Prescription Drug Plans adds prescription drug coverage to:
Original Medicare
Some Medicare Cost Plans
Some Medicare Private-Fee-for-Service Plans
Medicare Medical Savings Account Plans
These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Part D Prescription Drug Plans.
When Should I Sign Up For Medicare? Watch our Video to Learn More!
What factors can affect Medicare out-of-pocket costs?
Factors that affect Original Medicare out-of-pocket costs:
Whether you have Part A and/or Part B (most people have both)
Whether your doctor, other health care provider, or supplier accepts assignment
The type of health care you need and how often you need it
Whether you choose to get services or supplies Medicare doesn't cover (if you do, you pay all the costs unless you have other insurance that covers it)
Whether you have other health insurance that works with Medicare
Whether you have Medicaid or get state help paying your Medicare costs
Whether you have a Medicare Supplement Insurance (Medigap) policy
Whether you and your doctor or other health care provider sign a private contract
What’s not covered by Original Medicare (Part A & B)?
Medicare does not cover everything. If you need certain services Medicare does not cover, you will have to pay for them yourself unless:
You have other insurance that covers them
You have a Medicare health plan that covers them
Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayment.
Some of the items and services that Medicare does not cover include:
Long-term care (also called custodial care)
Most dental care
Eye exams related to prescribing glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care
What’s Medicare Supplement Insurance (Medigap)?
A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare does not cover, like:
Copayments
Coinsurance
Deductibles
Medigap policies are sold by private companies.
Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here is what happens:
Medicare will pay its share of the Medicare-approved amount for covered health care costs.
Then, your Medigap policy pays its share.
8 things to know about Medigap policies
You must have Medicare Part A and Part B.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you will each have to buy separate policies.
You can buy a Medigap policy from any insurance company that is licensed in your state to sell one.
Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company cannot cancel your Medigap policy as long as you pay the premium.
Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 are not allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
It is illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you are switching back to Original Medicare.
(Information from Medicare.gov)
What's a Medicare Advantage Plan?
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans/MAPD Plans”, are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).
Covered services in Medicare Advantage Plans
Medicare Advantage Plans cover all Medicare services. Some Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage.
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:
Whether you need a referral to see a specialist
If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care
These rules can change each year.
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors.
Drug coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:
Can’t offer drug coverage (like Medicare Medical Savings Account plans)
Choose not to offer drug coverage (like some Private Fee-for-Service plans)
You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:
You’re in a Medicare Advantage HMO or PPO.
You join a separate Medicare Prescription Drug Plan.
A Deeper Dive Into Supplemental & Advantage Plans…
How do I prepare for my appointment with Evolve Insurance Group?
Prepare a current list of your doctors
Prepare a current list of your prescription drugs
Organize a budget
Consider what is most important to you in your healthcare
Consider what extra benefits interest you
Bring a family member or friend if desired