INsurance Basics

Medicare insurance is a federally funded health insurance program managed by the Centers for Medicare & Medicaid Services (CMS). Often referred to as Original or Traditional Medicare, it encompasses Parts A and B. 

Part A, also known as Hospital insurance, covers inpatient hospital care, skilled nursing facilities, hospice care, and limited home healthcare. Part B, or Medical insurance, includes services such as doctor’s appointments, preventive measures, lab tests, X-rays, diagnostic tests, emergency care, injectable drugs, outpatient services, and durable medical equipment. For those looking for additional coverage beyond what Medicare offers, Supplemental insurance can be an option to consider, similar to Marketplace insurance plans.

Supplemental insurance, commonly known as Medigap insurance, offers financial coverage for expenses that Medicare insurance does not cover, including copayments, coinsurance, and deductibles. This type of coverage can be essential in managing out-of-pocket costs, similar to how marketplace insurance functions in providing additional protection.

Original Medicare insurance does not include pharmacy coverage, so individuals who require medication coverage can explore supplemental insurance options or purchase a pharmacy insurance plan from private companies that also offer marketplace insurance.

Original Medicare insurance does not include dental, vision, or hearing coverage. Individuals who need these benefits can explore supplemental insurance options or purchase dental, vision, or hearing insurance plans individually or through a combined plan, along with marketplace insurance choices.

Medicare Advantage plans, often referred to as Medicare Part C plans, are an alternative to Original Medicare and are purchased through private health insurance companies. These plans must provide the same services as Original Medicare, but they commonly include additional benefits such as pharmacy, dental, vision, and hearing coverage, as well as supplemental insurance options. This makes them a valuable choice for those exploring marketplace insurance and looking for comprehensive Medicare insurance solutions within a single plan.

Another form of federal health insurance for individuals and families who do not have access to employer-sponsored health insurance or a group health plan is known as ACA (Affordable Care Act) or marketplace insurance. These marketplace insurance plans are categorized as 'metal level plans' and include Bronze, Silver, Gold, and Platinum options. The distinction between each metal level is determined by the costs associated with covered healthcare services, which include both the plan expenses and those incurred by the member. Similar to other health insurance plans, these market-based options feature premiums, deductibles, copayments, and coinsurance. Additionally, individuals eligible for Medicare insurance may also consider supplemental insurance to cover gaps in coverage.