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!