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Medicare consists of two parts

  • Medicare Part A, which covers hospital care and has a $1484.00 deductible per stay
  • Medicare Part B covers basically all care outside of the hospital (doctor visits, tests, etc)
  • $203 Part B deductible- after deductible= Medicare Part B covers 80%, coinsurance 20%

 

Medicare Part C also called Medicare Advantage Plans-

  • offered by private companies-
  • required to provide the same benefits as Medicare Part A and B
  • over 25,000,000 Medicare Part C members¬†
  • several zero premium plan options
  • may include vision, hearing and dental coverage
  • SilverSneakers included in some plans
  • use a flat copay amount instead of 80/20 Medicare Part B structure

 

Types of Medicare Part C Plans

 

  • HMO plans- required you to assign a PCP (Primary Care Physician) and requires a referral to see a specialist
  • PPO plans- do not require you assign a PCP, do not need a referral to see a specialist and provides clients ability to see any in network doctor nationwide.
  • Medicare Advantage with Prescription drug coverage (MAPD)
  • Medicare Advantage without drug coverage (MA)¬†

 

Tricare for Life

Tricare for Life includes two major benefits- excellent drug coverage and covers the deductibles and copays that Medicare does not cover (Part A deductible=$1484 and Medicare Part B 20% copay). Tricare for Life works with BOTH Medicare Part A and B OR Medicare Part C. There are specific Medicare Part C plans that are designed for veterans. These plans are MA plans that do NOT have drug coverage because you already have great coverage with TFL. Most of the Part C plans designed for veterans  also include a Medicare Part B premium credit each month, plans vary from state to state.