Your Medicare Guide

Understanding
Medicare
Made Simple

Navigating Medicare's coverage gaps, costs, and options doesn't have to be overwhelming. We break it all down so you can make the right choice for your health and your budget. Keep scrolling to learn more...

An Ode to Medicare

In the land of healthcare, where troubles arise,

Original Medicare was birthed, a plan aged and wise.

But tests, procedures, prescriptions, you thought would be free,

Now cost a pretty penny, oh say can't you see?


Hearing aids, routine dental and vision to read at night

All out of reach and out of sight

You're stuck in the middle, feeling perplexed,

Medicare's coverage gap, what a cruel hex!


But fear not, dear friends, we'll find a way,

To close the gaps, laughing all the way!

For though coverage gaps may give us a fright,

Armed with information, we'll be alright!

The Foundation

3 Inalienable Facts About Medicare

Medicare is a great federal health coverage program, but it comes with truths every enrollee must understand.

1

Mind the Coverage Gaps

Original Medicare does not cover everything. Prescription drugs, routine dental, vision, hearing aids, and many other services are not included in your standard benefits.

2

Mind the Cost Gaps

Original Medicare is not free, and does not pay for everything it covers. You will still be responsible for premiums, deductibles, coinsurance, and copays.

3

Close the Gaps

The right plan for you depends on your health needs, finances, and how you want to access care. There is no one-size-fits-all answer.

Your Path Forward

Which Option Is Right For You?

Ask yourself the following three key questions. Your answers will guide you toward the Medicare coverage combination that fits your life. These are real choices with real trade-offs - take your time.

Hover over the underlined highlighted terms below to see their definitions.

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Important Reminder

You cannot combine Medicare Advantage and Medicare Supplement plans. You may not be able to easily switch later, so choosing wisely from the start matters greatly.

Choosing the wrong option may result in you paying more than you need, less coverage than you need, or worse - paying and still not getting the care you need.

Medicaid or Extra Help

D-SNP Available
Question: Do you qualify for Medicaid Medicaid A joint federal and state program that helps cover medical costs for people with limited income and resources. Eligibility rules vary by state. or other extra help?

If yes, enroll in both Medicaid and Medicare to maximize your benefits and reduce your costs. Additionally, if you are willing to accept an insurance company's network and pre-authorization for some services, you may also consider an MA D-SNP plan that comes with extra benefits.

  • Extra benefits: dental, vision, hearing, and over-the-counter (OTC) cards
  • Standard Medicaid may not cover some of these extras - the D-SNP plan fills that gap
  • Potential to greatly reduce or eliminate your monthly premium costs

Medicare Advantage Plan

Replaces Original Medicare
Question: Are you willing to accept an insurance company's pre-authorization and network restrictions in order to reduce or eliminate additional fixed monthly premiums?

Replace original Medicare with a Medicare Advantage plan that provides additional benefits not available with original Medicare - including drug coverage, routine dental, vision, hearing aids, wellness perks, and more.

  • Comes with a maximum out of pocket Maximum Out of Pocket (MOOP) The most you will pay for covered services in a plan year. After reaching this amount, the plan pays 100% of covered costs for the remainder of the year. ceiling to limit your annual exposure
  • You are still responsible for deductibles, Deductible The amount you pay out of pocket for covered health care services before your insurance plan begins to pay. coinsurance, Coinsurance Your share of the cost for a covered health care service, calculated as a percentage. For example, if your coinsurance is 20%, you pay 20% and the plan pays 80%. and copays Copay (Copayment) A fixed amount you pay for a covered health care service after you've paid your deductible. For example, a $20 copay for a doctor's visit.
  • Care restricted to insurer's network; some services may require pre-authorization
  • Comes with little or no additional monthly premiums, with some plans offering 'refunds' on original medicare premiums.

Medicare Supplement (Medigap)

Supplements Original Medicare
Question: Are you willing and able to pay additional fixed monthly premiums for maximum freedom in how you access care, without input from an insurance company?

Supplement original Medicare with a Medigap plan to address cost gaps not covered by original Medicare. This option gives you maximum flexibility in choosing your providers and receiving care.

  • Helps cover your deductibles, Deductible The amount you pay out of pocket for covered health care services before your insurance plan begins to pay. coinsurance, Coinsurance Your share of the cost for a covered health care service, calculated as a percentage. and copays Copay (Copayment) A fixed amount you pay for a covered health care service after you've paid your deductible.
  • Access any Medicare provider nationwide - no network restrictions
  • No insurer authorization required for Medicare-approved services
  • Does NOT include additional benefits - you must purchase drug, dental, vision, and hearing coverage separately
  • Comes with additional monthly premiumes and does NOT include 'refunds' for original medicare premiums.
⌛ Coming Soon

Real-World Scenarios
Are On The Way

We're building simulated real-world comparisons that show your actual benefits and costs across each Medicare option - so you can see exactly what works best for your situation. Watch this space!

Official Disclaimer

Medicare has neither reviewed nor endorsed this information. This website is not connected with or endorsed by the United States government or the federal Medicare program. The information provided here is for educational purposes only and is not a substitute for personalized advice from a licensed professional. Please contact the official resources below for help with plan choices.

🌐 Medicare.gov 📞 1-800-MEDICARE 🏠 State Health Insurance Program