Advanced Medicare

Created: Business to Individual

Medicare 201 Advanced information on Medicare Parts A, B and C, Medicare D (Rx) programs and a brief overview of Medicaid. Discussion and information on how and when to enroll and how it works with supplemental insurance.

Learn important skills from a licensed broker to

  • navigate drug formularies,
  • provider networks,
  • Medicare Advantage,
  • Prescription Drug Programs (MA-PDP) and
  • Medicare Supplement/Medigap plans.

This program provides a basic understanding of Medicare. This training module was developed and approved by the Centers for Medicare & Medicaid Services (CMS), the Federal agency that administers these programs.

This training is designed to provide basic information about Medicare, and other programs, and to provide you with resources to help you make informed decisions about your Medicare coverage.

You have choices in how you get your health and prescription drug coverage.
Your decisions will affect the type of coverage you get.
Timing of your decisions can be important as well.
There are certain decisions that are time sensitive to ensure coverage and avoid late enrollment penalties.

Topics Covered;
Medicare Part A, hospital insurance helps pay for medically necessary services. Hospital inpatient care – Semi-private room, meals, general nursing, and other hospital services and supplies. Includes care in critical access hospitals and inpatient rehabilitation facilities. Inpatient mental health care in a psychiatric hospital (lifetime 190-day limit). Skilled nursing facility (SNF) care (not custodial or long-term care) under certain conditions. Home health care – A doctor enrolled in Medicare, or certain health care providers who work with the doctor, must see you face-to-face before the doctor can certify that you need home health services. A Medicare-certified home health agency must provide your home health services. You must be homebound, which means that leaving home is a major effort. You pay nothing for covered home health services. Hospice Care – For people with a terminal illness. Your doctor must certify that you are expected to live 6 months or less. Coverage includes drugs for pain relief and symptom management; medical, nursing, and social services; and other covered services as well as services Medicare usually doesn’t cover, such as grief counseling. Blood – In most cases, if you need blood as an inpatient, you won’t have to pay for it or replace it. Medicare Part B covers medically-necessary services/supplies when certain requirements are met. Doctors Services – Services that are medically necessary. Outpatient Medical and Surgical Services and Supplies – For approved procedures (like X-rays, a cast, or stitches). You pay the doctor 20% of the Medicare-approved amount for the doctor’s services. You also pay the hospital a copayment for each service you get in a hospital outpatient setting. For each service, the copayment can’t be more than the Part A hospital stay deductible. The Part B deductible applies. You pay all charges for items/services that Medicare doesn’t cover. Durable Medical Equipment like walkers and wheelchairs. Preventive Services like exams, lab tests, screening and shots to help prevent, find, or manage a medical problem. Preventive services may find health problems early when treatment works best. Medicare Part A is premium free if you or your spouse paid Medicare, or Federal Insurance Contributions Act (FICA), taxes while working (10 year minimum in most cases). FICA funds the Social Security and Medicare programs. If either you or your spouse doesn’t qualify for premium free Medicare Part A, you may still be able to get Part A by paying a monthly premium. The amount of the premium depends on how long you or your spouse worked in Medicare covered employment. SSA determines if you have to pay a monthly premium for Part A.

If you don’t buy Part A when you’re first eligible, you may have to pay a monthly premium penalty. The premium is subject to a 10% increase payable for twice the number of full twelve month periods you could have been but were not enrolled.

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Matthew Byrne
About Matthew Byrne
Matthew Byrne has made a career helping people find affordable health insurance. He is the founder of Spiralight and, a Dublin-based brokerage providing health insurance for individuals, families and corporations.