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Garner NC
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FAQ
MEDICARE MADE EASY
Medicare Basics
Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home health services. Part B helps cover services from doctors and other healthcare providers, outpatient care, preventive services, durable medical equipment, and certain home health services.Original Medicare is administered by the federal government. You can also choose additional coverage, such as a Medicare Prescription Drug (Part D) plan or Medicare Supplement (Medigap) policy, or choose to receive your Medicare benefits through a Medicare Advantage plan.
Most people pay no monthly premium for Medicare Part A because they or their spouse paid Medicare taxes while working, generally for at least 10 years.The standard Medicare Part B premium is $202.90 per month in 2026. Some people pay a higher Part B premium based on their income.
In 2026, the Part B deductible is $283 per year. After meeting this deductible, you generally pay 20% of the Medicare-approved charges. For Part A, the inpatient hospital deductible is $1,736 per benefits period, covering the first 60 days. From days 61-90, the cost is $434 per day. Beyond 90 days, you pay $868 per "lifetime reserve day" for up to 60 days over your lifetime.Original Medicare does not have an annual out-of-pocket maximum
Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. Coverage can be provided through a stand-alone Medicare Prescription Drug Plan or through many Medicare Advantage plans that include prescription drug coverage.Each plan has a list of covered medications called a formulary. Plans may organize medications into different tiers, and your costs can vary depending on the medications you take, the plan you choose, and the pharmacy you use.It's important to review your Part D coverage each year because plan costs, formularies, and pharmacy networks can change.
Medicare Advantage, also known as Medicare Part C, is another way to receive your Medicare Part A and Part B benefits. Medicare Advantage plans are offered by Medicare-approved private insurance companies and must cover the medically necessary services that Original Medicare covers.Most Medicare Advantage plans include prescription drug coverage, and many offer additional benefits such as dental, vision, hearing, and fitness benefits. Depending on the plan, you may need to use a network of doctors and hospitals, and certain services may require prior authorization.Medicare Advantage plans also have an annual limit on what you pay out of pocket for covered Part A and Part B services. Premiums, copayments, provider networks, prescription coverage, and additional benefits vary by plan.
In general, you can pick one of two options for Medicare coverage when you are turning 65, or if you currently have original Medicare (Part A+Part B)
Medicare Advantage or Medicare Part C (combines all parts of Medicare into one)
Medicare Supplement with a stand alone Medicare part D plan (prescription coverage)
See flow chart attached.
There are certain times when you can enroll in or make changes to Medicare Advantage and Medicare prescription drug coverage.Initial Enrollment Period: When you first become eligible for Medicare, you have an opportunity to enroll in a Medicare Advantage or prescription drug plan.Annual Enrollment Period (October 15–December 7): You can join, switch, or drop a Medicare Advantage or Medicare prescription drug plan. Changes generally take effect January 1.Medicare Advantage Open Enrollment Period (January 1–March 31): If you're already enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or return to Original Medicare. You may also be able to enroll in a stand-alone Part D plan if you return to Original Medicare.Special Enrollment Periods: Certain life events or changes in circumstances may give you an additional opportunity to change coverage. Examples include moving, losing other coverage, or becoming eligible for certain assistance programs.Enrollment rules can vary depending on your circumstances. NC Senior Solutions can help you determine what enrollment opportunities may be available to you.
NC SENIOR SOLUTIONS
"Medicare simplified"
MEDICARE SUPPLEMENT
Medicare Supplement
Medicare Supplement Insurance, also known as Medigap, is private insurance designed to work alongside Original Medicare. It helps pay certain out-of-pocket costs that Original Medicare doesn't cover, such as deductibles, copayments, and coinsurance.Medigap plans are standardized, meaning the benefits of a particular lettered plan are generally the same regardless of which insurance company offers it. Premiums can vary by insurance company.With most Medicare Supplement plans, you can see any doctor or hospital nationwide that accepts Medicare. Medicare pays its share of covered services first, and your Medigap policy then pays according to the benefits of your plan.Medigap policies sold today do not include prescription drug coverage, so you may also want to enroll in a separate Medicare Part D prescription drug plan.
You can apply for Medicare Supplement during open enrollment. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or up to six-month after you turn 65 if you were eligible for Part B benefits before age 65.
They may increase but sometimes they decrease. You cannot be singled out for a premium change. The company may change premiums as a whole once a year.
Not everyone needs a Medicare Supplement plan. If you have coverage through an employer group health plan or are enrolled in a Medicare Advantage plan, you might not need extra coverage. Remember, Medicare Supplement plans don't coordinate benefits with Medicare Advantage plans.
No, a Medicare Supplement plan does not cover prescription drugs. You will need to enroll in a separate Part D plan for that coverage.
Yes, with a Medicare Supplement plan, you can visit any licensed doctor who accepts Medicare. There are no network restrictions, giving you the freedom to choose your healthcare providers.
No. Medicare Supplement (Medigap) is designed to work with Original Medicare, not Medicare Advantage.If you're enrolled in a Medicare Advantage plan, you can't use a Medigap policy to pay your Medicare Advantage copayments, deductibles, or premiums. In fact, it's generally illegal for an insurance company or agent to sell you a Medigap policy while you're enrolled in Medicare Advantage unless you're switching back to Original Medicare.If you're considering changing from Medicare Advantage to Original Medicare with a Medigap policy, it's important to understand your enrollment rights and whether you qualify for Medigap coverage before making the change.
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