Medicare Coverage Options In La Plata, Waldorf & Fort Washington, MD

Advantage and Supplements

Medicare Plans and How They Work

Medicare is the senior health insurance program run by the US Government. This coverage, possibly contrary all you have heard, is very good health insurance. That said, there are costs under the program that do come out of your pocket. Medical coverage (Part B) has a monthly premium that you will pay. A tremendous feature is the low deductible for your medical coverage. After the deductible is met, the coinsurance for services is typically 20% with Medicare picking up the 80%. Under Part B you will receive all doctor visits, durable medical equipment, therapy and some medicines are also included. Part B also pays your surgeon in the hospital.


Part A (hospital coverage) has a deductible for each hospital stay. You pay a deductible for a “benefit period”. The benefit period is a full 60 days from the date of admission. So, if you are in and out of the hospital during tis 60 period, there are no additional costs for your stay. Staying beyond the first 60 days has costs too. A daily rate is applied to each day after the initial 60 days up to 90 days. Beyond that, there are Lifetime days. Part A services include your hospital room and related services to the room, skilled nursing care (after a hospital stay) and home health care.

Medicare Supplement and Medicare Advantage plans

Medicare Supplements

With my clients, I often recommend a supplemental insurance plan as these are the easiest to maneuver. Supplemental insurance is secondary to Medicare to help pay for the deductibles and co-pays under Medicare. The supplement plans are designed by Medicare to help simplify getting the plan that fits you best. These “letter plans” describe the coverage details and every insurance policy under these plans will have identical coverage for each plan. The only difference from one carrier to another is what you pay for your policy. I look for the most cost-effective companies in the area to help my clients save on their premiums. Remember, all the letter plan policies are the same. The only difference is the cost. 


With supplemental insurance the only provider network involved is the doctor must accept Medicare payments. This makes it easy to go to the provider YOU want to see. Medicare supplement plans have a higher monthly cost than Medicare Advantage Plans, but they are true insurance and really provide the greatest coverage under Medicare. When you purchase a supplement, you will need to enroll in a Part D drug plan and any additional insurance needs (dental, vision…) separately. Just restate, Medicare Supplement Insurance is coverage you can take anywhere in the USA (coverage for overseas too!) and be seen by a Medicare doctor or stay at any hospital that treats Medicare patients.

Medicare Advantage Plans

I like to call these “pay as you go” plans. Medicare Advantage plans are not truly insurance, although many call it that. Advantage Plans are known for LOW monthly premiums and extra benefits. Most plans will include dental and vision coverage. Many also contain a Part D drug plan built-in so no separate drug plan is needed. These plans have fixed copays for most services and coinsurance for some benefits. Advantage coverage offers low up-front monthly costs that can make these plans very attractive. Often, Advantage plans will have network providers. Happily, these networks are usually quite large requiring little changing of your current providers. PPO plans allow you to see out-of-network providers covered at different payouts. Today’s Medicare Advantage Plans can be a great choice as you know what the costs of most of your services before you even see the doctor. I recommend these plans if you cannot afford the supplement premiums, are under 65 and on Medicare or, for some reason we cannot get you enrolled into a supplement. 


I also have additional insurance options to help you cover copays under your Medicare Advantage Plan (hospital indemnity plans). With this additional coverage, we can keep your “surprise” costs to a minimum offering you more comprehensive coverage at a very attractive price.


Which way you choose to receive your Medicare benefits, together we can figure out what works best for your situation. The BONUS is I come along at no charge with every plan choice!