What Is Medicare?


Medicare is a health insurance program for:

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Different Parts of Medicare


Original Medicare Includes Part A and Part B:

Part A - Hospital Insurance:
Part A helps cover inpatient care in hospitals, skilled nursing facilities (not custodial or long-term care), hospice and some home health care. Many people automatically get Part A after you get disability benefits from Social Security. Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Part B - Medical Insurance:
Part B helps cover doctors' services, outpatient hospital care, preventive care, physical and occupational therapists, and some home health care. Most people pay a monthly premium for Part B. You will need to sign up for Part B during your initial enrollment period (the 7-month period that begins 3 months before the month you turn age 65, includes the month you turn age 65, and ends 3 months after the month you turn age 65). If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

Part C – Medicare Advantage Plans:

Part C is Medicare Advantage plans (like HMO and PPO plans). PacificSource offers Medicare Advantage Plans. Part C is health coverage run by private companies like PacificSource under contract with Medicare. These plans include both Medicare Part A and Part B in the convenience of one plan and fill in some of the gaps in Medicare coverage. Some plans also include Part D Prescription drug coverage and preventive dental in the convenience of one plan. Most people will pay a monthly premium for this coverage. You must continue to pay your Part B premium and must have both Part A and Part B to enroll.

Part D - Prescription Drug Coverage:

Part D is prescription drug coverage run by private companies approved and under contract with Medicare. These plans help lower prescription drug costs and help protect against higher costs in the future. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later. Most people will pay a monthly premium for this coverage.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call (877) 486-2048, 24 hours a day/7 days a week;
  • The Social Security Office at (800) 772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users should call (800) 325-0778; or
  • Your State Medicaid Office.

What You Pay


Below are some of the costs you will pay if you only had original Medicare:

  • $134 monthly Part B premium *
  • $183 yearly Part B deductible (you must first pay this amount for covered services before Medicare begins paying for your coverage)
  • $1,316 per stay (day 1-60) in the hospital
  • $0 per day (days 1-60), $329 per day (days 61-90), $658 per day (days 91-150) and you pay the full costs for more than 150 days in the hospital
  • 20% of the costs for most services including doctor office visits, outpatient surgery, emergency and urgent care
  • $400 yearly Part D prescription drug deductible

* Most people will pay the standard monthly Part B premium. However, some people will pay a higher premium because of their yearly income (over $85,000 for singles, $170,000 for married couples). For more information about Part B premiums based on income, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call (877) 486-2048. You may also call Social Security at (800) 772-1213. TTY users should call (800) 325-0778. These premiums and costs may change yearly.


What Medicare Doesn't Cover


There are some limitations to Original Medicare. In most cases, the following are not covered:

  • you are not covered outside the United States
  • outpatient prescription drug coverage
  • no annual limit to your total out-of-pocket expenses (ex: you will continue paying 20% for most services all year)
  • not all doctors accept Original Medicare

Medicare Advantage and Medicare Supplement


If you decide you need extra coverage in additional to Original Medicare, you have two options for purchasing additional coverage through Medicare Advantage and Medicare Supplement plans. On both plans, you are still on Medicare. Here are the main differences between these plans:

Medicare Advantage Plan (like PacificSource Medicare plans)
These plans (PacificSource Medicare HMO and PPO plans) fill in the gaps by covering some of the costs Medicare does not cover. We provide more benefits than Medicare alone and Medigap plans. And we provide personal service to make it easy. We offer a variety of plans to meet your needs, including low-priced plans to help save you money. You will also get the convenience of plans that include medical (Part A and Part B) and prescription drug coverage (Part D) all in one plan. You also have the option to add preventive dental to your plan for an additional monthly premium.

Finding a doctor is easier because nearly every doctor in the region is accepted by PacificSource. And, with all our Explorer plans, you have the freedom to see any doctor you want that accepts Medicare wherever you are in the United States. Rest assured you are covered when you travel with worldwide* urgent and emergency care.

* Does not apply to the Essentials Rx 27 (HMO) plan

When you go to the doctor you will need only one ID card: your PacificSource Medicare ID card. The front of the card will show whether you have medical, prescription drug and/or preventive dental coverage. The doctor will need to send the bill to only one company, your Medicare Advantage plan like PacificSource Medicare. We will pay the bills on behalf of Medicare. Medicare reimburses us for their portion of the costs. Since we deal directly with Medicare, you and your doctor will have less paperwork.

Monthly premiums are the same for all ages. Everyone on one plan will pay the same premium for that year.

Medicare Supplement Plan (Medigap)
These plans also fill in the gaps in Medicare coverage. Original Medicare will cover the services under Part A and Part B. The Medigap plan will then cover some of the additional costs Medicare did not cover. If you also wanted Part D coverage, you would need to purchase a Part D prescription drug plan in addition to your Medigap plan.

Not all doctors accept Original Medicare. If your doctor does not accept Original Medicare, then you will either need to find another doctor, pay for the services yourself, or enroll in a plan that has a contract with your doctor. Generally, services outside the United States are not covered.

When you go to the doctor you will need two ID cards: your red, white, and blue Medicare card and your Medigap card. The doctor will need to send the bill to two places: first to Medicare to pay their portion and then to your Medigap plan to pay their portion.

Monthly premiums are based on your age.


Get More Information


Call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov for more information about Medicare benefits and services including general information regarding medical or Part D benefits. TTY users should call (877) 486-2048, 24 hours a day/7 days a week.

Or, come to an ABC’s and D’s of Medicare class sponsored by PacificSource. You can learn more about the often confusing process of the Medicare system, and how to make informed choices about health insurance. You’ll find the information you need to make the right decisions for you and your family. Classes are free and are open to the public. These events are only for educational purposes. No plan-specific benefits or details will be shared. Click here to see our events.