Medicare Options
Made Clear
Confused about Medicare? You're in good company! At FWT Insurance Services, we are experts in Medicare options. Let us help you navigate the programs and find you the best coverage.
MEDICARE OPTIONS EXPLAINED
Learn More About Your Medicare Options
Original Medicare
Original Medicare is a fee-for-service health plan offered by the federal government. It has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
You will need to pay premiums, deductibles, and coinsurance for covered services.
Original Medicare is the foundation for your Medicare coverage. You can also choose to add additional coverage, such as Medigap or a Medicare Advantage Plan, to enhance your benefits.
Medicare Part A (Hospital Insurance)
This plan covers inpatient hospital stays, skilled nursing facilities, hospice care, and home health care services. This usually requires a deductible and coinsurance for each service. You do not need to obtain prior approval from Medicare or your primary care doctor for services. It generally does not cover medical care outside the United States, except for emergency and urgently needed services.
Medicare Part B (Medical Insurance)
This plan covers outpatient services, such as doctor visits, surgeries, and durable medical equipment. This requires a monthly premium and a deductible, with coinsurance for each service.
Original Medicare Part B does not cover all services, such as:
- Routine physical exams
- Eye exams and most dental care
- Most hearing aids and hearing exams
- Long-term care services
Medicare Advantage (Part C)
Combines Part A and Part B coverage, plus additional benefits, such as:
- Dental, vision, and hearing care
- Fitness programs
- Rides to doctor appointments
- Prescription drug coverage (in most plans)
May offer extra benefits, varying by plan and provider.
Medicare Advantage Plans:
- Typically require you to stay within the plan’s network of providers
- Out-of-network care may incur higher costs or be partially or fully denied
- Emergency and urgent care are usually covered nationwide, regardless of network.
Medicare Part D
(Drug Coverage)
This is a US Federal program that helps Medicare beneficiaries pay for self-administered drugs. It covers most outpatient prescription drugs, including:
- Vaccines (except those covered by Part B)
- Most prescription medications
- Some medications explicitly excluded from Medicare coverage by law (e.g., weight loss/gain drugs, over-the-counter drugs)
This is offered through private companies as a stand-alone plan if you are enrolled in Original Medicare, or as part of the benefits included with Medicare Advantage Plans.
Medigap - What is it?
In Original Medicare, you generally pay some of the costs for approved services. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company to help pay your out-of-pocket costs that Original Medicare doesn’t cover.
FAQs
Here are some questions our clients have asked about Medicare. Please give us a call at 908-698-2150 and we would love to answer your questions.
Who is eligible for Medicare?
Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease). Check out Medicare.gov for more information on eligibility.
How do I sign up for Medicare?
Call the Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at www.socialsecurity.gov.
The Medicare.gov Web site also has a tool to help you determine if you are eligible for Medicare and when you can enroll. It is called the Medicare Eligibility Tool.
What's the difference between Medicare and Medicaid?
Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.
What are the Medicare premiums and co-insurance rates?
Most people don't pay a monthly premium for Medicare Part A (sometimes called "premium-free Part A"). If you don't qualify for premium-free Part A, you can buy Part A. If you buy Part A, you will pay either $259 or $471 each month in 2021. The standard Medicare Part B premium amount is $148.50 (or higher depending on your income) in 2021.You pay $203.00 per year for your Part B deductible in 2021. Medicare Part D requires a monthly premium, but deductibles vary among Medicare drug plans.
Are prescriptions covered with Medicare?
Medicare Part D is Prescription Drug Coverage. Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. For more information about this program, please visit: http://www.medicare.gov/part-d/index.html.
Are there different coverage plans available for Medicare?
Yes, Medicare offers different coverage plans, including Original Medicare (Parts A & B), Medicare Advantage (Part C), Prescription Drug Plans (Part D), and Medicare Supplement (Medigap) plans. Each plan provides varying levels of coverage to meet different healthcare needs.
Will my current provider take Medicare?
Medicare is accepted by many healthcare providers, but not all. It’s best to check directly with your provider or use Medicare’s online tool to verify their participation.