The 7 Need-to-Know Facts about Medicare

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Roy Welch

Medicare should be easy, not confusing. The following information can help you understand how Medicare works, and how to consider your choices. I can explain. With this knowledge you can start to think about how you want to receive you medical and drug plans through Medicare.

Medicare Part A (Hospital Coverage).

  • Most people will not need to pay a premium, some will.
  • There is a large deductible on the first day of a hospital stay.
  • After 60 days there is a daily coinsurance charge.
  • For Skilled Nursing coverage, it needs to follow an inpatient hospital stay of at least 3 days to enter a Medicare Approved skilled nursing facility.
I can explain how you can cover some or all of your cost for Part A

Medicare Part B (Doctors and Outpatient Services)

  • There is an annual deductible.
  • There is a basic monthly premium.
  • The premium can be increased due to IRMAA (Income related Monthly Adjustment Income)
  • You are responsible for 20% of all Medicare approved doctors and outpatient costs.
  • For outpatient hospital treatment there is a coinsurance charge.
I can explain how you can cover most costs of Part B

Medicare Part C. (Also known as the Advantage Plan)

  • You must live in the Advantage Plan service area.
  • Part C replaces the benefits of Medicare Part A and Part B.
  • There is an annual maximum-out-of-pocket for medical expenses.
  • Many Part C plans include the Part D drug plan.
  • These plans may have low to no monthly premium.
  • They may offer additional benefits.
I can explain how Part C (Advantage Plans) work and what is available in your area

Medicare Part C Special Needs Plans.

  • These are coordinated plans for a specific part of the population which include:
    1. An institutionalized individual
    2. Dual eligible, (meaning Medicare and Medicaid)
    3. An individual with a severe or disabling chronic condition, as specified by CMS.
  • There are three different types of SNPs.
    1. Chronic Condition SNP (C-SNP)
    2. Dual Eligible SNP (D-SNP)
    3. Institutional SNP (I-SNP
I can explain how Part C SNPs (Advantage Plans) work and if your qualify and if there is a SNP in your area.

Medicare Part D drug plan

  • If you do not apply for Part D Drug plan at your Initial Enrollment Period, you may have a late enrollment penalty.
  • Part D drug plan is offered through independent insurance companies.
  • Part D plans have formularies which make each plan different in premium and copays.
  • You have two ways to have a Part D plan; a stand-alone plan, or through a Part C Advantage Plan.
I can explain how Part D works with Advantage Plans and how it works as a stand-alone plan. You can save hundreds if not thousands of dollars depending on your medication and select the right plan for you.

Medicare Supplement Plans are also known as Medigap Plans.

  • You must have Medicare Part A and Part B and live in an area where they are offered.
  • You cannot have a Medicare Supplement Plan and a Medicare Part C Advantage Plan
  • Medigap plans are standardized with letters.
  • They have a monthly premium.
  • Premiums for the same type of Medigap plan can be as much as $100 per month difference in premium.
  • These plans help pay your cost for Medicare Part A and Part B.
  • They do not include a Part D drug plan.
I can explain how Medicare Supplement Plans work and show you the plan difference and cost difference for the same plan by various companies.


One big question is where do you go for answers you can trust now, and in the future?  A good broker will be available to help you with any questions you may have about your plan, doctors or any changes you might need. At Welch Insurance, our many years of experience with Medicare have always been about our clients benefit, at no cost or obligation.

I can explain the plans that best suit your needs.
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Have a chat with Roy about your present needs or to compare your present Medicare Insurance Plan to those that are available to you. There is no cost or obligation.

Roy Welch