Capitol Life | Medicare 101

Navigating Medicare

Understanding Medicare coverage can be daunting. We’ve broken down the basics of Medicare, and how Medicare Supplement insurance fits into the full picture. Some important things to note:

There are some rules around when you can enroll based on your current coverage and the date of your 65th birthday.
Medicare Supplement helps cover healthcare costs for Medicare recipients, like deductibles and co-pays.
Medicare terminology has a lot of terms that may or may not be familiar. Get to know them to make sense of your coverage.

Medicare Simplified

Medicare is the federal government’s health insurance program for people 65 and older. Medicare is divided into five parts, Parts A, B, C, D and Medicare Supplement (also known as Medicare supplement).

Parts A and B are provided through the government, while Parts C, D and Medicare supplement are insurance you get through private companies that help pay for the things Parts A and B do not cover.

Original Medicare

Part A
- Part A pays for hospital care, as well as some costs for stay in a nursing facility, healthcare at home, and hospice care for the terminally ill.
Part B
- Part B pays for doctor’s visits and preventive screenings and lab test, as well as some outpatient hospital car and home health care costs.

What Capital Life Offers

Medicare Supplement Plans
- Medicare Supplement Plans covers the cost gaps for what is covered by Parts A & B. Buying a Medicare Supplement plan helps you budget, and make sure you’re not hit with unexpected costs. As long as an expense is Medicare-approved, Med Sup will pay your outstanding balance on deductibles and copays.

Additional Medicare Parts

Part C
- Part C is an insurance plan that covers everything Parts A & B cover, with some additional coverage. People sign up for Part C instead of Parts A & B, but it is not right for everyone, since coverage options are very limited.
Part D
- Part D is a prescription drug plan. Everyone must enroll in a part D plan, regardless of if they take medication.

Medicare Costs & Medicare Supplement

Original Medicare covers many services, but care is not free. Parts A & B each have their own set premiums and deductibles, and Medicare supplement pays many of those copays and deductibles you’d otherwise pay yourself.

The Costs You’re Responsible For

Without Medicare supplement, these are some of the costs* you’ll need to pay

Part A hospital deductible (days 1-60) - $1364 per benefit period
Part B annual deductible - $185 per year
Most outpatient services and medical supplies - 20% of the total cost amount Medicare approves
Part A hospitalization co-pay (after day 60) - $341 per day**
Part A hospitalization (days 91-150) - $682 per day
Skilled Nursing Facility care (days 21-100) - $170.50 per day copay
Skilled nursing facility care (after day 100) - 100% of costs

*Based on 2019 costs

**Unless you have long-term care insurance or Medicaid

Different plans, different costs

Many different companies sell Medicare Supplement plans, but each company must sell the same standard benefits for each plan.The premium costs for individuals depends on their unique factors, such as current age, medical history, and the number of people on a policy.

You can compare the standard plans at medicare.gov with this online calculator.

What costs will you have to cover?

Use this list of costs you’ll have as a starting point to help determine what you want your Medicare Supplement insurance policy to cover.

Basic benefits (including hospice care)
Medicare Part A deductible
Medicare Part B deductible
Medicare Part B coinsurance
Medicare Part B excess charges
Skilled nursing facility coinsurance
Foreign travel emergency

See which of the Medicare Supplemental plans Capitol Life offers would work best for you.

Medicare Enrollment

There are a variety of rules surrounding when people are eligible for Medicare. For most people, they are eligible to enroll in Medicare Parts A & B during their Initial Enrollment Period, determined by their birthday. You may join Medicare Parts A, B and D during this time:

The 3 months before your 65th birthday
The month of your birthday
The 3 months after your birthday

If you did not sign up for Medicare when you were first eligible and did not have other insurance, you may face a penalty for late enrollment.

Medicare Supplement Enrollment

The Medicare supplement enrollment period is a 6-month period that begins on the first day of the month you turn 65 and are already enrolled in Part B. During your personal open enrollment period, you can buy any Medicare supplement policy.

If you apply for a Medicare supplement plan after your open enrollment period and you don’t meet the medical requirements, there’s no guarantee that an insurance company will sell you a policy. However, you may still be eligible if you have a guaranteed issue right, which generally applies when you have other healthcare coverage that changes, like if you lose that other coverage. Find out if you meet the requirements here.

And note that you do not have to re-enroll every year. As long as you pay your Medicare supplement premium, the company renews your policy automatically each year. This means that your coverage continues year after year as long as you pay your bill. Your policy is what is called “guaranteed renewable.”

Question about enrollment?
Call us at 866-237-3010

Health Insurance Glossary

Benefit period
- Starts the day you go to a hospital or skilled nursing facility, and ends when you have not received hospital or skilled nursing facility care for 60 consecutive days.
Coinsurance
- A percentage of Medicare-approved expenses not paid by Medicare.
Copayment
- A fixed fee amount that subscribers to a medical plan must pay when using specific services covered by an insurance plan.
Deductible
- Amount that one must pay for Medicare-approved expenses before Medicare begins to pay.
Eligible expenses
- Costs that are deemed medically necessary by Medicare and covered expenses under your plan.
Emergency care
- Immediate medical care needed because of an injury or illness of sudden and unexpected onset.
Excess charges
- The difference between what a health care provider is permitted to charge and the Medicare-approved amount.
Hospice care
- A program of care and support for someone who is terminally ill; helps them live out the time they have remaining to the fullest extent possible.
Medicare-approved amount
- In original Medicare, the total amount that a physician who accepts assignment can be paid – including what Medicare pays and any other deductibles, coinsurance or copayments.
Premium
- The periodic payment to Medicare, an insurance company, or a health care plan for coverage.

Medicare 101