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.