Medicare Visualized
You have two main choices when selecting your Medicare coverage:
Original Medicare or a Medicare Advantage plan.
Below is a simple map to help you visualize your two main Medicare options:
MEDICARE ROADMAP
Key Resources
Choosing the right Medicare coverage can feel overwhelming, but there are lots of resources to help you:
Medicare & You : click here to see this Medicare.gov resource.
Resource contacts:
- Medicare: 1-800-MEDICARE or www.medicare.gov TTY/TDD designated line 1-877-486-2048
- Social Security: 1-800-772-1213 or www.ssa.gov
- CMS www.cms.gov
- Statewide Health Insurance Benefits Advisors (SHIBA): www.insurance.wa.gov/about-shiba-services or call 800-562-6900, TDD: 360-586-0241
Prepare for your appointment with us:
Download a copy of our Scope of Appointment form to bring with your prior to your visit. CLICK HERE.
Helpful Terms to Know
Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go into a hospital or skilled nursing facility.
The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for
60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit
to the number of benefit periods.
Formulary
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription
drug benefits.
Medicare Advantage Plan
A Medicare insurance plan that replaces and enhances Medicare Part A and Medicare Part B. It combines the benefits of both parts and, in most cases, adds a few extra benefits such as prescription drug coverage.
Medicare Health Plan
A Medicare health plan is offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. This term is used to include all Medicare
Advantage Plans, Medicare Cost Plans, Medicare Innovation Projects and Programs of All-inclusive Care for the Elderly (PACE).
Medigap Plan
A Medigap plan is also known as Medicare Supplemental Insurance. The plan is not designed to replace any part
of Medicare. The Medigap plan is designed to cover expenses in whole or in part where Medicare leaves off.
The benefit of a Medigap plan is that it will help offset the out-of-pocket expenses that Medicare does not cover.
Primary Care Physician (PCP)
Your primary care physician is the doctor you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them. In many Medicare Advantage Plans, you must see your primary care physician before you see any other health care provider.