How Medicare works, in plain words.
I'm Erick Vallarino, a licensed Medicare agent here in the Valley. Medicare has four parts and a lot of mail. Here is how it fits together, the same way I explain it at the kitchen table. My help costs you nothing.
Each part of Medicare has its own job.
You'll see these letters on a lot of mail. Here is what each one is for.
Hospital
Part A helps pay when you are admitted to the hospital. It can also help with some care after a hospital stay, and with hospice.
Doctors and outpatient care
Part B helps pay for doctor visits, preventive care, lab tests and X-rays. Outpatient means the hospital did not admit you, even if you stayed the night.
Medicare Advantage
Part C is another way to get Medicare, through a private company approved by Medicare. It covers almost everything Parts A and B cover, and most plans include drugs too.
Prescription drugs
Part D helps pay for medicines from the pharmacy. You get it as its own plan, or inside a Medicare Advantage plan. Skipping it when you first qualify can mean a penalty later, so ask me first.
Turning 65?
Your window to sign up is 7 months long. I made a page just for you.
Original Medicare or Medicare Advantage?
You get Medicare one of these two ways. Neither one is right for everybody.
| Topic | Original MedicareParts A and B, run by Medicare | Medicare AdvantagePart C, from a private company |
|---|---|---|
| Doctors | Any doctor or hospital in the U.S. that takes Medicare. | Usually a network of doctors and hospitals. Some plans need a referral to see a specialist. |
| Drugs | You can add a separate Part D drug plan. | Most plans include drug coverage. |
| Extras | Many people add a Medicare Supplement (Medigap) to help pay their share of the bills Original Medicare covers. | Some plans add things Original Medicare doesn't cover, like some dental, vision or hearing care. |
| It can fit people who | want any doctor that takes Medicare, or travel a lot. | like one plan for everything, and whose doctors are in the network. |
Every year, from October 15 to December 7, you can change your Medicare Advantage or drug plan for the next year. That's when we sit down and go over what changed.
Medicaid is a different program.
The names sound alike, so people mix them up all the time.
What is Medicaid?
Medicaid helps people with limited income and savings pay for health care. Each state runs its own. Medicare is mostly for people 65 and older, and some younger people with disabilities.
Can I have both?
Yes, some people have both, and the two work together. Some Medicare plans are made just for them. I can help you apply for Medicaid, and for Extra Help with drug costs.
Where do Medicare.gov and 1-800-MEDICARE fit?
They are Medicare's own website and phone line. They can show you every plan in your area, and I don't offer every plan. What I add is a person who sits down with you, and stays after.
The questions that matter.
Before you pick any plan, ask these. I go through every one with you, at your kitchen table or at my office.
- Are my doctors and my hospital in the plan?
- Are all my medicines covered?
- Which pharmacy costs me less?
- Do I need a referral to see a specialist?
- What if I get sick while I travel?
- Does it work with my other coverage, like Medicaid or insurance from work?
I'm an independent agent. I don't work for an insurance company. If you're better off staying put, I'll tell you.
Still have questions? That's what I'm here for.
No question is too small. I'll explain it as many times as you need, in English or Spanish. My help costs you nothing.