medicare basics
Start with Original Medicare
Original Medicare, a health insurance program managed by the federal government, is for people 65+ or who have certain disabilities. Each part of Original Medicare, Part A and Part B, needs to be purchased separately. Original Medicare will not cover all your Medicare expenses and does not include prescription, dental, vision or hearing coverage.
Medicare Basics: Original Medicare
Next, choose additional coverage
Original Medicare doesn’t cover everything. That’s why most people choose between Medicare Advantage and Medicare supplement, purchased through a private insurance company, in order to get the complete Medicare coverage they need.
Option 1: Medicare Advantage (Part C)
All coverage rolled into one plan
Part A (Hospital)
Part B (Doctor)
Part D (Drugs)
Dental
Vision
Hearing
GymPart A
Part A is covered and paid for by Part C.
Inpatient hospital coverage is free to those who paid Medicare taxes for 10 years; others will pay a monthly premium. Part A covers:
- Hospital stays and skilled nursing facility care
- Hospice and some home health care
Part B
Part B is covered in Part C, and some Medicare Advantage plans will pay for the Part Bmonthly premium.
Outpatient medical coverage — for doctor visits. A monthly premium External Link is required. Once the deductible is met, you pay 20%. Part B covers:
- Doctor visits
- Durable medical equipment (crutches, wheelchair, blood sugar meters, etc.)
- Outpatient services (such as lab tests)
Part D
Part D is covered and paid for by Part C.
Drug coverage is included in all Wellmark Advantage Health Plan options.
- Includes thousands of generic and brand name drugs
Additional included benefits
Wellmark's Medicare Advantage (Part C) plans include:
Medicare Advantage Basics
Option 2: Medicare supplement (Medigap) + Part D
Individual, stand-alone, customized plans
Part A(Hospital)Part B(Doctor)Part D(Drugs)
Supplement(Medigap)Part A
Inpatient hospital coverage is free to those who paid Medicare taxes for 10 years; others will pay a monthly premium. Part A covers:
- Hospital stays and skilled nursing facility care
- Hospice and some home health care
Part B
Outpatient medical coverage — for doctor visits. You will pay a monthly premium External Link. Once the deductible is met, you pay 20%. Part B covers:
- Doctor visits
- Durable medical equipment (crutches, wheelchair, blood sugar meters, etc.)
- Outpatient services (such as lab tests)
Add-ons to Original Medicare
Part D
Drug coverage is not included in Original Medicare or Medicare supplement. Even if you don't use medication currently, you should purchase a prescription drug plan through a private insurer as soon as you can enroll to avoid paying a late enrollment penalty External Link.
- Has a monthly premium
- May have out-of-pocket costs and a deductible
- Includes its own list of covered drugs called a formulary
Supplement
Medicare supplement (Medigap) assists with out-of-pocket costs not covered by Original Medicare.
- Covers what's left over after Original Medicare pays your claims (deductible, copayment and coinsurance)
- Includes a monthly premium with various levels of coverage to choose from
- Gives you the freedom to choose any Medicare provider, anywhere
Wellmark MedicareBlue SupplementSM plans are not connected with or endorsed by the U.S government or the federal Medicare program.
Dental, vision, hearing
Dental, vision and hearing coverage is not included in Original Medicare or Medicare supplement and needs to be purchased separately.
Avēsis Vision is an independent vision insurance company that does not provide Wellmark Blue Cross and Blue Shield of South Dakota products and services. Avēsis Vision is underwritten by Fidelity Security Life Insurance Company, Kansas City, Missouri. Hearing Discount Savings Plan provided by Amplifon. Amplifon is an independent company that does not provide Wellmark Blue Cross and Blue Shield of South Dakota products or services.Medicare Supplement Basics
Want to see more differences between Medicare Advantage vs. supplement?
Now that you understand the basic differences between Original Medicare, Medicare Advantage and Medicare supplement, see which coverage is right for you.
Working Past 65?
Understand what you need to do for Medicare if you work past age 65.
Still have questions?
If you'd rather talk to someone to get your questions answered about your options in Iowa or South Dakota, call a Medicare expert, at no cost.
