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Understanding Medicare

Medicare can be confusing. We can explain your options and assist you with getting this big decision right the first time.

What is Original Medicare?

Medicare is a federal 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.

Medicare includes four components. Part A is hospital insurance, Part B is medical insurance, Part C is Medicare Advantage plans and Part D is prescription drug coverage.

Part A

This covers hospital bills for inpatient stays as well as things like home healthcare, hospice or nursing care. There usually is not a premium associated with Part A.

Part B

This covers doctor, outpatient hospital, diagnostic tests, ambulance, durable medical equipment and other home health care services that are not covered under Part A. There is a premium for Part B and this premium changes every year. Typically, this premium is automatically deducted from your Social Security check.

Part C

This is for those who are enrolled in a Medicare Advantage Plan. 

  • It includes all benefits and services covered under Part A and Part B
  • Some plans include Medicare prescription drug coverage (Part D) and other extra benefits and services

Part D

This is the voluntary prescription drug benefit program that went into effect in 2006. Part D gives all Medicare beneficiaries the option to purchase prescription drug coverage from the company of their choice. When you become 65 and you do not enroll in any other type of plan, you will have Original Medicare coverage. Original Medicare coverage by itself does not include prescription drug coverage.

What are my coverage options to replace or supplement Original Medicare?

There are a variety of options available to those eligible for Medicare. SummaCare offers Medicare Advantage plans and an optional supplemental dental plan. 

Medicare Advantage Plans

Medicare Advantage (MA) plans “take the place of” your Original Medicare coverage. They are offered through private insurance companies, like SummaCare. When you join an MA plan, you become a member of that plan and no longer need to use your red, white and blue Original Medicare card. You still must pay your Medicare Part B premium, however, your MA plan becomes your primary insurer.

Medicare Advantage plans are designed for those who are eligible for Medicare and typically offer cost effective benefits at higher coverage levels and feature lower out-of-pocket costs than Original Medicare. In addition, many Medicare Advantage plans offer prescription drug coverage along with medical coverage for one monthly premium. These are called Medicare Advantage Prescription Drug (MAPD) plans.

Medicare Advantage plans are “all-in-one” – meaning, your medical, prescription drugs (included with MAPD plans), dental and other healthcare coverage is all in one, convenient budget-friendly plan.

SummaCare offers both MA and MAPD plans, and our plans go beyond basic Medicare with valuable extra benefits designed to keep you healthy. Learn more about SummaCare’s Medicare Advantage plans.

Supplemental Dental Plans

Many Medicare Advantage plans feature preventive or comprehensive dental coverage, but many plans offer the option to add supplemental dental coverage for an additional monthly premium. Dental services are received through the dental provider’s network, and the monthly premium typically enhances the level of coverage and network of providers to which the member has access.

Through SummaCare’s partnership with Delta Dental of Ohio, you’re covered for two cleanings and exams, an X-ray plus visits for dental pain through the Delta Dental Medicare Advantage PPO network. Comprehensive dental coverage is included with the Garnet plan. Supplemental dental coverage can be purchased for an additional monthly premium. Learn more about SummaCare’s Medicare Advantage plans.

To enroll in a MA, MAPD or supplemental dental plan, you must physically enroll by contacting a plan and completing the appropriate paperwork. You cannot or will not be automatically enrolled in this type of plan once you become eligible for Medicare. Unlike Original Medicare, you cannot or will not be automatically enrolled in this type of plan once you become eligible for Medicare.

Extra Benefits Included

Valuable extra benefits are included with all SummaCare plans including dental, vision and hearing aids! Most plans also include BrainHQ, Family On-Demand with Papa, Travel Coverage and more.

Attend an Event

Learn why 97% of our members stay year after year by attending a free, informational event. A SummaCare Medicare Advisor will walk you through our plans and coverage options, and answer any questions you may have.