Education Center
The Different Parts of Medicare

What do the parts of Medicare cover?
 
Medicare (Part A)

Part A is hospital coverage. It covers care you receive while an inpatient in a hospital, skilled nursing facility, home healthcare, hospice or need blood.
 
Medicare (Part B)

Part B is Medical coverage. It covers doctor visits, clinic services, preventative, ER and Urgent care and care you receive as an outpatient including durable medical equipment.
 
Medicare (Part C)

Part C is Medicare Advantage. These plans combine the coverage of Parts A and B into one plan. They often include prescription drug coverage and extras like Dental, Vision, Hearing, Gym Memberships and more.
 
Medicare (Part D)

Part D is prescription drug coverage. Plans cover many medications that are prescribed by your doctor or other qualified health professionals.
 

Understanding Your Medicare Choices

Within Medicare (Part A) and (Part B) you may choose:
 
Option 1: Medicare Supplement (Medigap) + Medicare (Part D)

Medicare Supplement plans are designed to “Supplement” or cover the gaps in the original Medicare program.  You may choose a plan to cover the cost of certain deductibles, co-pays and co-insurance cost.

  • WI, MN and MA are called Standardized States offering a basic plan plus your choice of additional riders (additional coverage options) to customize your plan.
  • The rest of the USA has pre-built plans to choose from labeled with a letter.
  • All plans work the same and follow all federal and state Medicare coverage guidelines.

 
Option 2: Medicare Advantage

Medicare Advantage plans combine the benefits of Medicare (Part A) and (Part B) and typically include (Part D) built into the plan. These plans have low premiums with a Pay-As-You-Go structure where you pay co-pays for services you need throughout the year.

  • Medicare Advantage plans are required to provide you coverage at least as good or better then Medicare (Part A) and (Part B) and will cover all services normally covered by (Part A) and (Part B). You may also find plans that have additional coverage and services provided that are not normally covered by original Medicare (Part A) and (Part B). Such as Medicare (Part D), Dental, Vision, Hearing, Free Gym Memberships, and more.
  • Many people ask how a Medicare Advantage plan can offer all of these benefits at such a low or in some cases no monthly cost. This answer is simple, the federal government (i.e., Medicare) pays the insurance company of your Medicare Advantage choice a monthly administrative fee to the fund the coverage of benefits and services at least as good as Medicare. This administrative fee can be $700/month or more.

 
Option 3: Additional Circumstances

If you are eligible to join an employer or group healthcare plan and/or qualify for Medicaid your situation may be unique. Be sure to contact an independent agent to discuss your options.

  • Employer or Retiree Group Health Plan
  • Medicaid

 

Timing Considerations

Annual Enrollment Period (AEP): October 15th to December 7th
 
Why are the AEP dates important?

Whether you’re new to Medicare, getting ready to turn 65, or preparing for retirement–you will need to make several important decisions in the near future. If you wait to enroll, you may be subject to costly penalties or lack of coverage so it’s important to contact an independent agent to assist you with the process. Follow these steps from Medicare.gov to learn more.

What changes can you make during the AEP?

During the Annual Enrollment Period you have the right to review you Medicare plan options and make changes to your plan. It’s important to keep in mind that changes you make during this time go into effect January 1st of the next year. This may include the following:

  • Change to a Medicare Advantage plan from Original Medicare, (Part A), and (Part B).
  • Change from a Medicare Advantage plan to Original Medicare, (Part A), and (Part B).
  • Change from one Medicare Advantage plan to another (regardless of whether either plan offers drug coverage).
  • Enroll in a (Part D) prescription drug plan.
  • Change from one Medicare prescription drug plan to another.
  • Opt out of Medicare prescription drug coverage completely.

 
Can you make changes to your plan after the Annual Enrollment Period?

From January 1st to March 31st of each year is called the Medicare Advantage Open Enrollment Period (OEP). During this time you have the right to make a one-time change to your Medicare Advantage and/or (Part D) prescription drug plan. This may include the following:

  • Change to a new MA or MAPD plan.
  • Return to Original Medicare (Part A) and (Part B).
  • Your new plan will start the 1st of the following month after you complete the application.

 

Disability, End Stage Renal Disease, Kidney Transplant Eligibility

You’ve just been diagnosed with a disability and may qualify for Medicare. Now what?
 
What You Can Expect

The type of disability has everything to do with when your coverage begins, and whether you are automatically enrolled or if you need to take steps to start the enrollment process. Here’s additional resources from Medicare.gov to learn more:

 

How the Affordable Care Act Works

What is the Affordable Care Act?
 
How it Works

The Affordable Care Act (ACA or “Obamacare”) was signed into law by President Barack Obama in 2010. A major overhaul of the U.S. health-care system, Obamacare aims to reduce the amount of uncompensated care the average U.S. family pays for by requiring everyone to have health insurance or pay a tax penalty.

 

Join an Educational Event

Learn the Basics of Medicare
 
Reserve Your Spot

Join Sovereign Select for a FREE educational event to better understand The Road to Medicare and the tools you need to get started. Click here for dates, locations and registration.
 

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