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Medicare FAQs and Information to Consider

What are the ONLY TWO Choices for Receiving Medicare Coverage?

You have two choices for receiving your Medicare coverage when you turn 65. You can get your Medicare benefits through Original Medicare or a Medicare Advantage Plan. Understanding the difference between Original Medicare and a Medicare Advantage Plan is the first step in getting the coverage that is right for you and protecting the quality of your healthcare now and in the future. Don’t be fooled or misled. Get the facts.

What is Original Medicare?

Original Medicare is the federal government-run health insurance program for people who are 65 or older. One of the many benefits of turning 65 is receiving Medicare benefits regardless of your health. If you are receiving social security benefits, you will be automatically enrolled in Medicare Part A and Part B when you turn 65. Your Medicare benefits will become effective on the first day of your birth month. The only exception is if your 65th birthday falls on the first day of the month. In this case, your effective date would be the first day of the previous month. Your Medicare card will be mailed to you approximately three months before your 65th birthday.

Under Original Medicare, the government pays healthcare providers directly for the services you receive. With Original Medicare, there are no network restrictions. That means you have the freedom to choose any doctor, specialist or hospital anywhere in the USA when you need care. When enrolled in Original Medicare you do not need to get prior approval, referral or permission from Medicare or from your primary care doctor when you need care. You just provide your red, white and blue Medicare card to receive Original Medicare services. Most people with Medicare get their health coverage directly through Original Medicare.

What is a Medicare Advantage Plan?

Don't be fooled by a Medicare Advantage Plan. A Medicare Advantage Plan is health insurance provided by private insurance companies that are contracted by Medicare and provide a different way to get your Medicare benefits. Each Medicare Advantage Plan must provide services offered by Original Medicare, but can do so with different rules, costs and restrictions that can affect how and when you receive care.

If you enroll in a Medicare Advantage Plan, there are network restrictions. This means you are required to see the healthcare providers in the Medicare Advantage network; plus, in most cases, you will need to get prior approval when you need care, except in case of an emergency. With a Medicare Advantage Plan, the insurance company has been given the ability to make its own claims decisions, and some claims decisions have been made with profitability in mind. If you enroll in a Medicare Advantage Plan, you MUST follow the rules of the Medicare Advantage Plan you have joined.

Also, if you enroll in a Medicare Advantage Plan you will automatically be dis-enrolled from Original Medicare and you will NOT be able to use your Medicare card.

What Is Medicare Supplement Insurance? 

Medicare supplement insurance is offered by private insurance companies. Medicare supplement insurance covers some of the gaps not paid by Original Medicare Parts A and B. With Original Medicare and a Medicare supplement, you are protecting the quality of your healthcare NOW and in the FUTURE. Medicare supplement insurance provides choice, control, freedom, flexibility, and value. With a Medicare supplement, there are no network restrictions. That means you can choose any doctors and hospitals, and visit any specialists anywhere in the USA that accepts Medicare patients.

All Medicare supplement insurance plan benefits are set by the federal government. That means the basic benefit structure for each plan is the same, no matter which insurance company is selling it to you. However, the prices vary widely among the various insurance companies. Plan G is the most popular Medicare Supplement Plan today. Plan G covers 100% of all Medicare-eligible charges, except the coverage of the $183 Medicare Part B calendar-year deductible. The Medicare Part B deductible is only paid ONCE during a calendar year. 

Can I use my Medicare Card with my Medicare Advantage Plan?

NO. You will NOT be able to use your red, white and blue Medicare card when you go to the hospital, doctor, specialist or any healthcare provider. This means you are no longer enrolled in the federal government-run health program. This also means you must follow the rules of the Medicare Advantage Plan you have joined. When you join a Medicare Advantage Plan, you are required to use the Medicare Advantage Plan insurance card when you visit the healthcare providers in their network and NOT your Medicare Card.

What to Look for in A Good Medicare Supplement Policy?  

Shopping for a Medicare Supplement policy?  All Medicare Supplement Plan benefits are set by the federal government - the ONLY difference is PRICE. That means there is no difference in the benefits you receive under one company’s plan versus another. However, the prices vary widely among the various insurance companies. The first thing to consider is the price when choosing a good policy. In addition, you should consider the company’s overall reputation, financial rating, household discounts and the number of years the company has been selling Medicare Supplement Plans. 

Our Medicare Specialists can help you avoid the pitfalls. We can help you compare all the leading companies in your area. We will bring all the numbers to the table and you decide what coverage is best. 

Can I qualify for a 12% household discount?

Yes. With some companies, you automatically qualify for a 12% household premium discount if you have a spouse/partner, friend or relative that you have lived with for the past 12 months.  With other companies, to qualify for a discount, your spouse/partner must be a policyholder with the company to qualify for the household premium discount.


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