Understanding Medicare can be a challenge, especially with all the unique terms and rules that come with it. To help simplify things, we’ve broken down the five most important Medicare-related terms that you need to know:

1. Premium

Just like with private insurance, Medicare premiums are the monthly amounts you pay to maintain your coverage. While Medicare Part A (hospital insurance) doesn’t usually have a premium for those who qualify through their work history, Medicare Part B (medical insurance) and Medicare Part D (prescription drug coverage) both require monthly premiums. These premiums are essential for maintaining your coverage, but they don’t cover the full cost of your healthcare services.

2. Deductible

The deductible is the amount you must pay out-of-pocket before Medicare begins covering your services. For Medicare Part A, the deductible applies to inpatient hospital stays, while for Medicare Part B, it applies to outpatient services like doctor visits and lab tests. After meeting your deductible, you may still have additional costs, such as copayments or coinsurance, depending on the specific services you receive.

3. Copayment (Copay)

A copayment (or copay) is a fixed amount you pay for certain services after meeting your deductible. For example, Medicare Part B services often have a copay, like a set cost for a doctor’s visit. In Medicare Part A, rather than a copay, you might pay coinsurance for extended hospital stays. Copayments are a way for Medicare to share costs with you, reducing your out-of-pocket burden.

4. Coinsurance

Coinsurance is a percentage of the cost that you pay for services once you’ve met your deductible. For example, after your hospital stay under Medicare Part A, you might pay coinsurance for each day beyond a set period. In Medicare Part B, coinsurance typically involves paying a percentage of the cost for outpatient services, like lab tests or certain treatments, after your deductible is met.

5. Maximum Out-of-Pocket

Unlike many private insurance plans, Original Medicare (Parts A and B) doesn’t have a set maximum out-of-pocket limit. This means that once you meet your deductible and coinsurance obligations, you could still face significant costs for your care. However, Medicare Advantage (Part C) plans do have an out-of-pocket maximum, capping your yearly healthcare expenses. For those with Original Medicare, it’s important to budget for your healthcare costs carefully, as there is no cap on your spending.

Why These Terms Matter for Medicare

Understanding these terms is crucial when navigating Medicare. They help you anticipate and manage your healthcare costs, and knowing what each term means can empower you to make the best choices for your health and finances. Whether you’re new to Medicare or reviewing your current plan, being familiar with these terms will help you better manage your coverage and avoid unexpected costs.

Get Help Finding the Right Medicare Plan

Choosing the right Medicare plan can be complicated, but you don’t have to do it alone. At Medicare Info, we connect you with a licensed insurance agent who is ready to help you understand your Medicare options and find a plan that fits your needs and budget. Whether you’re considering Medicare Advantage, Part D prescription drug coverage, or simply reviewing your current coverage, we’re here to guide you every step of the way.

HMO, PPO, EPO: Breaking Down Health Insurance Plans Without the Headache

Navigating health insurance can feel like learning a whole new language—HMO, PPO, EPO, copay, deductible… it’s enough to make your head spin.

But don’t worry—we’re here to simplify the jargon and help you understand the most important details so you can choose the best health insurance plan for your needs (and your budget).

Let’s break it down:

HMO: Health Maintenance Organization

Looking for a budget-friendly plan with predictable costs? An HMO might be for you.

• Lower premiums and fixed copays
• Requires you to choose a Primary Care Physician (PCP)
• Referrals needed to see specialists
• Only covers in-network providers

This plan works best if you’re comfortable sticking with one doctor and staying within a defined provider network. Just make sure you choose a PCP you trust—they’ll be your go-to for all things healthcare-related.

PPO: Preferred Provider Organization

If flexibility matters more to you, a PPO plan offers more freedom—at a higher price.

• Higher premiums than an HMO
• No referrals needed to see specialists
• Coverage for both in-network and out-of-network care
• Lower out-of-pocket costs when you stay in-network

A PPO is a solid choice if you regularly visit healthcare providers or want the ability to see specialists without jumping through hoops.

EPO: Exclusive Provider Organization

EPOs are something of a middle ground between HMOs and PPOs.

• Only covers in-network care
• Typically no referrals required
• Larger network than an HMO
• Premiums vary depending on the plan

This plan is great if you’re okay staying in-network but want a wider range of doctors to choose from—and fewer restrictions when seeing specialists.

Final Thoughts

Understanding the differences between HMO, PPO, and EPO plans can make choosing the right health insurance much easier. It all comes down to your healthcare needs, preferences, and budget.

At Medicare Info, we make it simple to explore your options. Our licensed insurance agents are here to help you find a plan that fits your life—and your wallet.

Ready to get started? Let us guide you to the coverage that works for you.

What is Medigap and Do I Need It?

Have you heard of Medigap and wondered how it differs from a Medicare Advantage plan? It can be confusing to navigate the world of Medicare options, but we’re here to break down the key differences to help you make an informed decision.

Medigap vs. Medicare Advantage: Key Differences

• Premium Costs: Medigap typically has higher premiums compared to Medicare Advantage, which often offers lower monthly costs.
  
• Out-of-Pocket Expenses: With Medigap, you’ll generally pay fewer out-of-pocket costs for medical care. On the other hand, Medicare Advantage tends to have higher out-of-pocket expenses.
  
• Where You Can Receive Care: Medigap is accepted nationwide, so you can receive care anywhere in the U.S. Medicare Advantage, however, is typically limited to specific regions and states.
  
• Provider Network: Medigap doesn’t require you to stay within a specific network of providers, while Medicare Advantage plans do, meaning you’ll need to use in-network doctors and hospitals for the best coverage.
  
• Prescription Drug Coverage: Medigap doesn’t include prescription drug coverage (Part D), so you’d need to enroll separately for that. Medicare Advantage, however, usually includes prescription drug coverage as part of the plan.

Navigating Medicare options can be overwhelming, but you don’t have to do it alone. If you have more questions or need guidance, Medicare Info is here to connect you with a licensed health professional who is ready to provide you with personalized information and resources, making the decision process easier. Connect with a licensed Medicare specialist near you today!

Traveling This Summer? Here’s What You Need to Know About Medicare Coverage

Are you planning to travel within the U.S. this summer? The good news is that most doctors and hospitals accept Original Medicare. If you experience a sudden illness or injury, Medicare Part B typically covers emergency medical care while you’re away.

However, if you’re heading abroad, there are a few important details to consider. Medicare does not cover medical expenses incurred outside the U.S. This includes not reimbursing for prescription medications you purchase while overseas. That said, Medicare may cover certain services abroad, such as inpatient hospital care, ambulance services, or dialysis in foreign hospitals, but coverage is often limited.

For additional protection when traveling internationally, Medigap (Medicare Supplement insurance) can be a lifesaver. Medigap is designed to work alongside Original Medicare, helping to cover costs that Medicare doesn’t pay, such as copayments, coinsurance, and deductibles. Importantly, some Medigap plans offer emergency medical coverage for situations that occur outside of the United States. This is a huge benefit for anyone who plans to travel abroad and wants peace of mind knowing they’re covered if an unexpected health issue arises.

Not all Medigap plans offer this benefit, so it’s essential to choose the right plan based on your travel needs. Medigap Plan C and Plan F, for example, offer foreign travel emergency health coverage, but you’ll need to check with your provider to ensure it’s included in your specific plan.

In addition to offering overseas protection, Medigap helps cover costs not included in Original Medicare, such as:

• Deductibles: Medigap can help you pay for the out-of-pocket costs associated with Medicare Part A and Part B deductibles.
  
• Coinsurance and Copayments: Medigap covers some or all of the coinsurance and copayments that Original Medicare doesn’t cover.
  
• Extended Hospital Stays: If you require additional hospital days beyond what Medicare covers, Medigap can pick up the cost.

If you’re concerned about medical expenses while traveling or want to reduce your out-of-pocket costs at home, Medigap can provide extra peace of mind.

Still unsure which plan is right for you? Fill out our form, and a live insurance expert from Medicare Info will reach out to you to discuss your options and get the coverage you need today!

Medigap, also known as a Medicare Supplement plan, is offered by private companies to help cover the costs that Original Medicare doesn’t pay for. This includes expenses like copayments, coinsurance, and deductibles, which can add up quickly without additional coverage.

If you’re someone who enjoys traveling internationally, Medigap plans also offer the added benefit of coverage when you’re outside of the United States—something Original Medicare doesn’t provide. To qualify for a Medigap plan, you must already be enrolled in Medicare Parts A and B.

Medigap vs. Medicare Supplement: What’s the Difference?

There’s often confusion about Medigap and Medicare Supplement plans. To clarify, here are some key distinctions:

• Premium Costs: Medigap premiums tend to be higher than those for Original Medicare.
• Out-of-Pocket Costs: Medigap helps minimize your out-of-pocket expenses.
• Where You Can Receive Care: Medigap works in any state, providing flexibility in where you seek care.
• Provider Network: No network restrictions; you can see any doctor who accepts Medicare.
• Prescription Drugs: Medigap plans do not include prescription drug coverage (Medicare Part D is required for that).

Navigating Medicare and its various plans can be overwhelming, but Medicare Info is here to make the process easier. Connect with a team of licensed insurance professionals who are ready to assist, offering expert guidance and resources to help you make informed decisions. Fill out a form today to connect with a Medicare specialist in your area!

If you need help paying for health insurance in 2025, your eligibility will depend on your income and state of residence. Under the Affordable Care Act (ACA), subsidies have helped reduce costs for millions of Americans. However, the enhanced subsidies that were introduced under the American Rescue Plan Act (ARPA) and extended through the Inflation Reduction Act (IRA) are set to expire at the end of 2025. The Trump administration is not expected to renew these enhanced subsidies, which could make coverage more expensive for many Americans purchasing insurance through the ACA marketplace.¹

As of now, you may still qualify for ACA subsidies if your health insurance costs exceed 8.5% of your household income. However, policy changes under the Trump administration could impact subsidy availability, Medicaid expansion, and other aspects of healthcare access.¹ The benchmark plan used to calculate subsidies remains the second-lowest-cost Silver plan available in your state’s marketplace.

If you rely on ACA subsidies to afford coverage, it’s important to stay informed about potential legislative changes and explore alternative options as policies evolve.

Here are updated tips for estimating your expected household income for 2025 before applying for health insurance savings:

1. Estimate Your Expected Household Income for 2025
   • Start with your Adjusted Gross Income (AGI) from your most recent tax return. If you don’t have an AGI, estimate using federal taxable wages and other income sources.
   • Add any non-taxable income that applies, such as tax-exempt Social Security benefits, foreign income, and tax-exempt interest.
   • Adjust your estimate based on expected raises, job changes, or additional income sources during the year.²
     
     
2. Include the Right People in Your Household
   • Count yourself, your spouse, and all dependents you claim on your federal tax return, even if they don’t need coverage.
   • If a dependent earns enough to file a tax return, their income must be included in your estimate.³
     
     
3. Know the 2025 Income Limits for ACA Subsidies
   • Individuals: Income between $15,060 and $60,240 (100%-400% of the Federal Poverty Level) qualifies for subsidies.
   • Families: A household of four earning up to $124,800 may still qualify for financial help.⁴
     
     
4. Report Any Changes During the Year
   • If your income changes after you apply, update your Marketplace application as soon as possible to ensure you receive the correct subsidy.⁵

Wherever you are in your health insurance journey, Medicare Info is here to help connect you to a licensed insurance agent to help find the right plan for you.

Sources:
¹ https://revelation-partners.com/the-trump-administrations-impact-on-healthcare-a-2025-outlook
² https://www.healthcare.gov/income-and-household-information/how-to-report
³ https://www.healthcare.gov/income-and-household-information/how-to-report
⁴ https://www.aura-insure.com/post/your-no-nonsense-guide-to-aca-income-limits-for-2025
⁵ https://www.healthcare.gov/income-and-household-information/how-to-report

Maximize Your Health Benefits with These Smart Tips

Healthcare costs can add up quickly, and while comprehensive plans often come with a hefty price tag, they might not always cover the things you truly need. At Health Plans America, we’re committed to helping you make the right choices for both your health and your budget. To help you get the most out of your coverage, we’ve put together a few valuable tips to maximize your health benefits:

1. Schedule Non-Emergency Procedures Early
   Plan non-urgent procedures early in the year to help you meet your deductible and maximize your coverage.
   
2. Audit Your Medical Bills for Errors
   Mistakes happen, but they shouldn’t come at your expense. Regularly review your medical bills to ensure there are no errors that could impact your finances.
   
3. Maximize Tax Savings with a Health Savings Account (HSA)
   Consider using an HSA to save on taxes. The money you contribute to an HSA is pre-tax, which can make a significant difference come tax season.
   
4. Shop Around Before Enrolling
   Health insurance laws change regularly. Always shop around to ensure the plan you’re enrolling in provides the coverage you need at the best price.
   
5. Save Money on Prescription Drugs
   Reach out to your insurance provider to understand exactly what prescription drugs are covered. If you’re facing high out-of-pocket costs, consider exploring other options.

Understanding your health insurance options is key to making informed decisions about your coverage. With Medicare Info, finding the right plan for you is simple and hassle-free. Connect with a licensed insurance agent today to discover a healthcare plan that fits your lifestyle and budget.

4 Important Medicare Gaps You Need to Know About

While many people are familiar with the coverage Medicare provides, it’s equally important to understand what it doesn’t cover. Here are four key areas where Medicare falls short:

1. Prescription Drugs: Original Medicare doesn’t include prescription drug coverage. However, you can add this coverage through Medicare Part D or choose a Medicare Advantage plan, which bundles both medical and drug coverage.
2. Long-Term Care: Medicare covers certain nursing services but doesn’t provide for custodial care, such as assistance with daily activities like bathing and dressing. For this type of care, long-term care insurance is your best option.
3. Deductibles and Copays: Even with Medicare Part A and Part B covering some hospital stays and doctor visits, you’ll still be responsible for deductibles and copayments. Medicare Advantage plans, offered by private insurers, can help fill in these gaps.
4. Dental Care: Routine dental services, such as checkups, cleanings, fillings, dentures, and extractions, aren’t covered by Medicare. Some Medicare Advantage plans may offer limited dental coverage, such as basic cleanings and X-rays, but often with coverage caps.

If you’re unsure about your Medicare options or need assistance navigating these gaps, a Medicare Info insurance professional can guide you through the process and help you find the right coverage. Reach out today!

In today’s world, where technology is everywhere, it can be difficult to tell if you’re falling victim to a scam. When it comes to your health, however, scams and fraud can have a serious impact on your peace of mind and overall well-being.

As we begin the New Year, here are some simple yet effective steps you can take to protect yourself from Medicare scams:

Stay Alert for Suspicious Activity
Be vigilant and trust your instincts. If something feels off, take a moment to assess the situation. Scammers often rely on pressure and urgency, so don’t hesitate to pause and question their motives.

Ask Questions and Seek Trusted Advice
If you’re ever uncertain, ask questions. Whether it’s about a phone call, email, or in-person interaction, probing deeper can help expose scammers. Consult with a trusted friend, family member, or advisor to get a second opinion.

Review Your Statements Regularly
Keep an eye on your Medicare Explanation of Benefits (EOB) and monthly statements. Regularly reviewing these documents ensures you catch any discrepancies or fraudulent activity early on.

Consult Your Doctor, Not Strangers
Scammers may try to convince you that they have your best interests at heart. However, your primary care doctor is the true expert when it comes to your health and care options. Always rely on them for medical advice.

Report Suspicious Activity
If you suspect you’ve encountered a scam, report it. Chances are, you’re not the only one. By reporting the issue, you help protect yourself and others in your community from potential fraud.

With so much information out there, knowing where to start can feel overwhelming. That’s where Medicare Info can help. They provide the resources and guidance you need to make informed decisions with confidence.