Contact of Visit Today

ICUSA Office Locations

If you’re looking for a local insurance company that’s committed to helping you understand your options and providing you with the best quotes available, call or visit the nearest Insurance Connection USA location nearest you.

Medicare Basics

Exploring the fundamentals of Medicare: what it is, what it covers, and what you should know.

What is Medicare?

Federal health insurance for people 65+ and some under 65 with disabilities.
Part A: Hospital insurance (inpatient, skilled nursing, hospice, some home health).
Part B: Medical insurance (doctor visits, ambulance, equipment).
Not covered: vision, dental, hearing, long-term care, most prescriptions.

Original Medicare

The federal government provides Part A and Part B, also known as Original Medicare. You must be enrolled in Original Medicare before you can sign up for additional coverage (Medicare Supplement, Part D, or Medicare Advantage).

Part A is hospital insurance. It helps cover:

Inpatient hospital care
Short-term skilled nursing facilities
Hospice care
Some home health care services
Part A deductible is $1676.00 per hospital admit

Original Medicare

The federal government provides Part A and Part B, also known as Original Medicare. You must be enrolled in Original Medicare before you can sign up for additional coverage (Medicare Supplement, Part D, or Medicare Advantage).

Part B is medical insurance. It helps cover:

Doctor visits
Tests and Labs
Ambulance services
Durable medical equipment
The Part B deductible is $257.00/year
Part B only covers 80% of the Medical costs with No Out of Pocket Max

What Does it Cost Me?

Part A and Part B have monthly premiums, deductibles and coinsurance. Most people don’t pay the Part A premium thanks to the Medicare taxes they paid while working.

Everyone pays the Part B premium currently $185.00/month. This amount changes yearly and varies based on income.

If you enroll late in Part B, you could have a penalty fee added. Plus, there is no limit on what you pay out of pocket with Original Medicare.

What is Not Covered?

While Original Medicare provides coverage for hospital and medical services, it doesn’t cover everything.
In general, Original Medicare pays for only 80% of covered health care costs. It’s up to you to pay the remaining 20%.
Plus, Original Medicare doesn’t cover most prescription drugs or other benefits such as vision, dental, hearing services, or long-term nursing and home health care.

Additional Coverage

Many choose to buy additional insurance to help cover the 20%. Some choose a Medicare Supplement (Medigap) plan and/or a Part D prescription drug plan, while others choose a Medicare Advantage plan.
Let’s take a closer look at additional coverage by starting with Medicare Supplement and Part D.

Medicare Supplement and Part D

Medicare Supplement (Medigap) and Part D prescription drug plans (PDP) work alongside Original Medicare. These plans are made available through private health insurance companies, although they are regulated by the government.
In other words, you must enroll in Parts A and B and either (or both) Medicare Supplement and Part D for more comprehensive health care coverage.
Medicare Supplement plans help pay your share of health care costs, such as copays, coinsurance, and deductibles. They also have their own monthly premium.

Part D Rx Plans

Part D prescription drug plans (PDPs) are stand-alone plans that help pay for medications you buy from a pharmacy or through a mail-order pharmacy service.
PDPs have their own monthly premium, plus a yearly deductible, copays, and coinsurance.
While Part D is technically optional coverage, if you sign up late for a PDP, you may face a permanent late enrollment penalty tacked on to your premium.
If you decide to go the path of Original Medicare plus additional coverage, you should consider enrolling in Part D as soon as you’re eligible to avoid penalties.
Part D plans may feature these pharmacy types as part of their network: Retail chain or big box store pharmacies, mail order, specialty pharmacies, and long term care pharmacies. These plans may also feature preferred pharmacies, where you pay a lower copayment for prescriptions—a real cost savings compared to paying for prescriptions elsewhere.

What Does a Supplement Cost?

Health insurance companies set the prices for these types of coverage. Costs can be determined by things such as age, whether you use tobacco, and your location (ZIP Code).
Original Medicare, Medicare Supplement, and Part D aren’t the only option available to you. There’s one more we’ll cover and that’s Part C, also known as Medicare Advantage.

Medicare Supplement and Part D

Works with Original Medicare (Parts A & B).
Medigap helps cover costs: copays, coinsurance, deductibles.
Part D helps cover prescription drugs.
Late enrollment penalty applies if you delay Part D.

Medicare Advantage

Health insurance companies provide Medicare Advantage plans that are regulated by the government. These plans are sometimes referred to as an “all-in-one” option. They combine Original Medicare services with benefits such as vision, dental, hearing, or prescription drug coverage.
These plans don’t replace Part A and Part B. You still need to enroll in Original Medicare before you enroll in a Medicare Advantage plan. Advantage plans are Medicare replacement plans, meaning they replace your original Medicare Part A and B
Medicare Advantage comes in different flavors, but we’ll focus on the two that are commonly used: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

Both HMO and PPO Plans

Provide Part A and Part B benefits (hospital and medical insurance)
Typically offer prescription drug coverage they also have a Max out of pocket that can range from $3200 to $7100 depending on the plan
Have networks for provider and pharmacies
Require you to have Original Medicare and live in service area*
Feature out-of-pocket maximums, unlike Original Medicare

* You must keep paying your Part B monthly premium; a Medicare Advantage plan’s monthly premium doesn’t replace the Part B premium.

How HMOs and PPOs Differ

HMO

Typically, out-of-network provider or pharmacy coverage isn’t allowed
May feature lower monthly premiums, copayments, and deductibles
Usually require you to choose a primary care physician (PCP)
Referrals required for in-network specialists in most cases

PPO

Cover out-of-network providers also but usually at a higher cost
May feature higher monthly premiums, copayments, and deductibles
You don’t need to choose a primary care doctor
No specialist referrals required in most cases

Other HMO/PPO Considerations

Before picking either an HMO or PPO Medicare Advantage plan, make sure the plan covers your area, the doctors you prefer to see, and the services you need. Find out the rules involved with emergency medical situations. Know your costs! What are the monthly premium, copays, deductibles, and out-of-pocket maximum? Having a clear sense of these details will help you decide which is the better option for you.

What does it cost me?

Medicare Advantage costs and coverage can differ from plan to plan. Most plans have a monthly premium (although some are as low as $0), deductibles, copays and out-of-pockets maximum.
With a Medicare Advantage plan, you still have to pay your monthly Part B premium.

Medicare Advantage (Part C)

All-in-one option, provided by private insurers.
Includes Part A & B benefits plus extras (vision, dental, hearing, drugs).
Requires enrollment in Parts A & B first.
Types: HMO (low cost, restricted) and PPO (flexible, higher cost).

Choosing Additional Coverage

Supplement + Part D vs Medicare Advantage.
Both help pay what Original Medicare doesn’t cover.
Consider flexibility, costs, and coverage when choosing.

Choosing Medicare Supplement and Part D Plans May Mean...

MEDICARE SUPP / PART D

Separate monthly premiums for Medicare Supplement and Part D
Limited out-of-pocket costs for hospital and medical care
No network restrictions seeing a doctor or going to the hospital
Extra benefits (dental, vision, hearing, etc.) purchased separately

These may be good for those who:

Are comfortable paying higher monthly premiums in order to limit out-of-pocket spending on health care
Want the freedom to access doctors/hospitals throughout the US
Can afford to buy extra benefits separately

Picking a Medicare Advantage Plan May Mean...

MEDICARE ADVANTAGE

Premiums as low as $0
A maximum out-of-pocket limit for hospital and medical care
Network restrictions for seeing doctors or going to the hospital
Prescription drug plan and extra benefits are often included

These may be good for those who:

Want a lower monthly premium and are comfortable paying copays and deductibles for health care services
Are comfortable seeking care within a defined provider network
Want prescription drug coverage and extra benefits (dental, vision, hearing, etc.) included

Which May Be Right for You?

Supplement + Part D: Higher premiums, limited OOP costs, nationwide access.
Medicare Advantage: Low or $0 premiums, OOP maximum, extra benefits included.

Enrollment

Let’s move on to another important topic: how (and when) you should sign up for Medicare.

In general, people become eligible to sign up for Medicare 3 months before and 3 months after their 65th birthday month. As you near 65, you should ask yourself “Do I need Medicare coverage right now?”
Some people have health insurance through an employer and want to continue that coverage. Others may be coming off their health insurance and need to switch to Medicare.
If you plan to make Medicare your primary source of health insurance, you should enroll in Part A and Part B as soon as you become eligible and start considering the additional options we’ve covered.
We recommend you contact Social Security to enroll in Part A and Part B and determine how you’ll pay for it (usually the premiums are deducted from your retirement benefits, although direct bill is another option). If you already receive Social Security retirement benefits, you’re automatically enrolled in Part A and Part B when you turn 65.

Enrollment

Eligibility: 3 months before and after your 65th birthday.
Automatic enrollment if already on Social Security.
If working, you may delay Part B with employer coverage.
Enroll via Social Security (online, phone, or in person).

Next Steps

Now that you’ve explored the basics, let’s talk.
Professional advisors can answer your unique questions.
Make sure your Medicare decision fits your health and budget needs.

This general insurance glossary defines some of the terms you’ll hear when discussing insurance. However, there are many, many other terms that are helpful to understand. Our agents would be happy to help you decipher the jargon and clear the clutter so you can make the best decision when it comes to home, life, auto, business or any other type of insurance. Just reach out!

Health Insurance

Deductible: All individual and group health plans have a deductible. The deductible is the dollar amount an insured individual must pay for covered expenses during a calendar year before the plan begins paying co-insurance benefits.

Coinsurance: the percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member’s co-insurance is 20%.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan’s stop loss amount.

Co-Pay plans vs. Saver plans: A co-pay plan has a predetermined, flat fee that an individual pays for health-care services, in addition to what insurance covers. A Saver Plan does not have a co-pay and the individual is responsible for paying for all health-care services until the deductible is met.

Stop-loss: the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

Automobile Insurance

Coverage Limits: The highest dollar amount the insurance company will pay if you make a claim on a “covered loss.”

Uninsured Motorist: Endorsement to a personal automobile policy that covers an insured collision with a driver who does not have liability insurance.

Medical Payments PIP: medical payments coverage protects your passengers, and any family members driving in the insured vehicle at the time of the accident.

Comprehensive Insurance: Auto insurance coverage providing protection in the event of physical damage (other than collision) or theft of the insured car. For example, fire damage or a cracked windshield would be covered under the comprehensive section.

Collision: Covers physical damage to the insured’s automobile (other than that covered under comprehensive insurance) resulting from contact with another inanimate object.

Towing (Road Side Assistance): It is an addition to your auto insurance policy that allows you to either get direct towing service from the Insurance Company or to be reimbursed for expenses relating to needing a tow truck.

Home Owners Insurance

Dwelling coverage: This is the part of the policy that covers the actual structure of your home. There are various policy types ranging from basic ACV to all perils replacement cost.

Basic will only cover the actual cash value of a home and does not take into account the depreciation of the property. This opens up a lot of possibilities that a claim will be denied by an insurance company.
The dwelling value for a replacement cost policy will typically be calculated based on many factors including square footage, year built and any customization work. If you are concerned about being overinsured or underinsured, give us a call. Most people want to be sure they are covered in the event of a loss so be sure you have the right policy for you before you have a claim.

Personal Property: This is the part of the policy that would cover the contents (furniture, clothing, electronics, etc.). Many times there are limits on items like jewelry, guns, silver/gold, and fine art. If you think you have pieces that might be over a couple thousand dollars per piece, contact Insurance Connection USA and we will be able to schedule this property on a personal articles policy or a blanket policy.

Medical Coverage: You may also see this coverage called “Guest Medical” or “Medical Payments to Others”. This is Coverage designed to pay for medical expenses to others who are accidentally injured on an insured location or by the activities of an insured. No Negligence on the part of the insured has to be proven for payment to be made

Slab and foundation coverage: This is an additional coverage especially important in Texas. If there is a leak in the plumbing, heating, air conditioning, or automatic fire protective sprinkler system then the foundation, floor slab, or footings that support the dwelling will be covered. This includes the cost of tearing out the floor and foundation to access the leak. This does NOT cover the repair of the actual plumbing system where the leak originated. Various limits are available, but the best companies will cover up to the limit of your dwelling coverage.

Personal Liability: Liability coverage provided by the homeowners policy that protects the insured against the financial consequences of liability to others for bodily injury and property damage. This coverage also insures the cost of defense in addition to the policy limit.

Deductibles: This part of the policy specifies what amount you are responsible for FIRST before the insurance company will pay for any claim. In some areas, there are 2 or 3 different kinds of deductibles, depending on what type of loss occurred.

Part 1 is typically for wind/hail and generally, there is a minimum deductible of 1%. What this 1% means is that the deductible equals 1% of the dwelling amount (coverage A). An example is if your home is covered for $100,000 then your deductible will be $1000.

Part 2 typically is for All Other Perils. So if you have an open perils policy, then every cause of loss, except wind and hail will carry that deductible. This can range from anywhere starting at $250. Call Insurance Connection USA if you would like to increase or decrease your deductible.

Umbrella Insurance

Umbrella policies supply extra coverage in the event of a lawsuit. Just as umbrellas shield you from rain, umbrella policies protect you from losing the entirety of your wealth and assets. These policies supplement your personal policies by covering beyond the limits of liability associated with those policies. Also, you chose how much more it covers; typically starting around $1 million.

You must have advanced limits of liability on the entirety of your personal policies before they offer the option of an umbrella policy. Typically, the limits of liability needed are $250,000 for bodily injury protection per person and $500,000 per accident.

Life Insurance

Types of life insurance

Term life insurance is an insurance policy covering a person’s life for a specified number of years. It is often offered with a guaranteed premium for a particular number of years. Term life does not have accumulated cash value. Accumulated cash value generally is the distinction between term life insurance and whole life or universal life insurance. Cash value policies are initially much more expensive than term life insurance policies for the same amount of coverage.

Universal Life Insurance – A combination of flexible premium, adjustable life insurance policy
Whole Life Insurance – Life insurance which might be kept in force for a person’s whole life and which pays a benefit upon the person’s death, whenever that might be.

How much coverage do you need? There is no set rule as to how much insurance you need to purchase. You need to decide how much life insurance you want to leave your dependents to carry on in your absence. You have to decide how much support you wish to provide. Many financial planning experts recommend 10 to 20 times your annual earnings. For business life insurance the amount is often even more. For many, the answer is simply the amount makes you feel your family is safe.

Long Term Care Insurance

Long-term care insurance is a type of insurance developed specifically to cover the costs of long-term care services, most of which are not covered by traditional health insurance or Medicare. These include services in your home such as assistance with Activities of Daily Living as well as care in a variety of facility and community settings.

There is a great deal of choice and flexibility in long-term care insurance policies. You can select a range of care options and benefits that allow you to get the services you need in the settings that suit you best. The cost of your long-term care insurance policy is based on the type and amount of services you choose to have covered, how old you are when you buy the policy, and any optional benefits you choose, such as Inflation Protection.

Long-term care insurance policies have a benefit period or lifetime benefit maximum, which is the total amount of time or the total amount of dollars up to which benefits will be paid. Common benefit periods for long-term care policies are two, three, four, and five years, and lifetime or unlimited coverage. Other options between five years and lifetime/unlimited coverage are also available from many companies. Most policies translate these time periods into dollar amounts and do not actually limit the number of days for which they will pay for care – just the overall dollar amount that the policy will pay. There are fewer companies today willing to offer an unlimited/lifetime policy, although some have a “high coverage option” like a $1 million lifetime limit.

With long-term care insurance, you pay premiums in amounts you know in advance and can budget for, and the policy pays – up to its coverage limits – for the long-term care you need when you need it. Typically, premiums are waived during the time you are receiving benefits.

Call us for more information about your insurance questions.

Medicare Can Be Confusing

We understand. That's why we wrote a simple guide to help you decipher the terms, makes sense of the options and gain enough insight to make an informed decision.

If you're not ready to reach out to Bob and the Insurance Connection team, please grab your free copy of The ABC’s & D of Medicare. Learn More

Rewrite for Locations

Frequently Asked Questions

What happens if I don't enroll in a Part D plan when I'm first eligible?

If you don’t sign up for a Part D plan when you first become eligible and don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty. This penalty is a permanent addition to your monthly Part D premium for as long as you have coverage.

How do I choose the right Part D plan?

The best plan for you depends on the medications you take. You should compare plans based on their formularies, premiums, deductibles, and the copayments for your specific drugs. We can help you use Medicare’s tools to compare plans and find the one that is most cost-effective for your situation.

Can I change my Part D plan?

Yes. You can change your Part D plan every year during the Annual Open Enrollment Period, which runs from October 15 to December 7. This is a great opportunity to review your coverage and make sure your plan still meets your needs for the upcoming year.

Important Highlights



Medicare Part D provides coverage for prescription drugs through private plans.



To join a Part D plan, you must be enrolled in Medicare Part A or Part B.



Costs include a monthly premium, an annual deductible, and copayments/coinsurance for each prescription.



It’s crucial to check a plan’s formulary to ensure your specific medications are covered.

Contact Medicare Support

}

Monday – Friday
9:00am – 5:00pm CST



Click to Call:
940-382-4700

Like what you see?

Put Insurance Connection to Work for You

Reach out for a free, no obligation consultation. We're here to help.

CALL 940-382-4700

Learn More About ICUSA