Planning for Medicare
The Centers for Medicare and Medicaid Services (CMS) oversees the Medicare landscape. For many, this is a very confusing time with lots of questions that need informed answers. We have been Medicare Advisors for a long time and can help you navigate the ever-changing opportunities and regulations that you need to cicumvent. "Original Medicare" combines Part A and Part B. Together, they will cover roughly 80% of the care that you will need. We then will want to create a plan for the other 20%.
Part A
Part A
Part A
Often referred to as “hospital” coverage, Medicare Part A helps cover inpatient hospital stays, skilled nursing facility care, home health services, and hospice care. You may see any provider anywhere in the United States, as long as they accept Original Medicare.
Part B
Part A
Part A
Known as “medical” coverage, Medicare Part B helps pay for services from doctors, specialists, and other health care providers. It also covers outpatient care, home health services, durable medical equipment such as wheelchairs, walkers, and hospital beds, as well as preventive services and wellness visits.
Part C
Part A
Part C
Also called "Medicare Advantage", these plans are an alternative to Original Medicare. Offered by private insurance companies, they typically combine Part A, Part B, and Part D coverage into a single plan. Most plans require you to use doctors within their network and may need prior approval for certain services.
Part D
Part A
Part C
Medicare Part D provides coverage for prescription medications. Each plan has its own formulary, which is the list of drugs it covers. Most plans require you to meet a deductible before moving into the copay phase. Starting in January 2026, the maximum out-of-pocket cost for all beneficiaries will be $2,100.
Medicare pathways - the other 20%
Medicare Supplement (Medigap)
A Medicare Supplement or Medigap plan works with Original Medicare (Parts A & B) and can take care of any deductibles or copayments that Medicare does not cover. The most common plan is Plan G which after a small deductible will take care of these copays and deductibles associated with Original Medicare. Plan N is also popular in that it has the same small deductible plus a small copay when you see your provider and an emergency room visit. These plans are popular due to the limited out-of-pocket costs and the ability to see any provider in the USA, without needing a referral or prior approval so long as the provider accepts Original Medicare.
Medicare Advantage - Part C
A Medicare Advantage plan replaces Original Medicare completely providing all care under one plan (except Hospice which is always covered by Part A). These plans incorporate Parts A, B and D under one insurance policy issued be the carrier. These plans have lower monthly premiums, even as low as $0 per month. Like any employer group health plan, these plans will have copays and co-insurance costs when you use the plan. With most of these plans, you will need to see a provider in a certain network and you will need a referral and prior authorization when using the plan's benefits.