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Medicare 101


Understanding Medicare

Medicare involves a lot of complicated terms, documents and requirements. Below are some important things to know about the program whether you're nearing age 65 or are enrolled and need a better understanding.


The Parts of Medicare

Part A: Hospital Insurance

  • Health insurance provided by the Federal Government
  • Covers inpatient hospitalization, skilled nursing facilities, hospice care, surgery and home health care
  • Most people should enroll at age 65, even if they have other insurance
  • Most people do not pay a premium

Part B: Medical Insurance

  • Health insurance provided by the Federal Government
  • Covers doctor care, durable medical equipment, outpatient surgery and chiropractic care
  • If you have employer coverage, check with your employer to see if you should also have Part B
  • Most new enrollees pay a standard monthly premium which can be deducted from your Social Security check or billed directly to you
  • Higher-income beneficiaries may pay an Income Related Monthly Adjustment (IRMA) amount in addition to the standard premium

Medigap Plans

Medicare Part A and Part B do not cover all expenses. A Medicare Select plan like Health Tradition 65Plus helps to close Medicare gaps. Medicare Supplement or Medicare Select plans can also be called “Medigap” plans.

  • Available from private insurance companies and regulated by the State of Wisconsin
  • Plans pay some or all of the costs Medicare does not pay
  • Guaranteed acceptance during your open enrollment “window”
  • Guaranteed renewable for life

Part C: Medicare Advantage

  • A type of Medicare health plan offered by a private insurance company that contracts with Medicare
  • Responsibility to administer your Medicare Part A and Part B benefits is transferred to the plan
  • Monthly premiums vary and you continue to pay your Part B premium
  • You usually pay a copayment or coinsurance for covered services; each plan can charge different out-of-pocket costs and have different rules for how you get services
  • Renewal is not guaranteed
  • Not required to provide Wisconsin mandated benefits as Medigap plans are

Part D: Prescription Drug Plan

  • Optional benefit offered directly by private insurance companies
  • Each plan has a list of covered drugs (formulary) and may have a pharmacy network
  • Monthly premiums vary by plan
  • There are extra costs for delaying enrollment when eligible for Medicare Part A and B, unless you’re switching from other creditable drug coverage or qualify for extra help
  • Higher-income beneficiaries may pay a Part D income-related monthly adjustment (IRMA) amount in addition to the monthly plan premium
  • Often used in combination with Original Medicare and a Medigap plan

Additional Resources

Download the Glossary of Health Coverage and Medical Terms prepared by the Centers for Medicare & Medicaid Services (CMS) that explains insurance concepts and terms.

The Wisconsin Guide to Health Insurance for People with Medicare gives an overview of the Federal Medicare program and the health and prescription drug insurance available to those on Medicare in Wisconsin.

SeniorCare is a prescription drug assistance program for Wisconsin residents who are 65 years of age or older who meet the enrollment requirements. The program is designed to help seniors with their prescription drug costs.

This is an advertisement for insurance. In offering Medicare Select insurance, neither Health Tradition Health Plan nor its agents are connected with Medicare.

HT MC 3023