Medicare Basics

The healthiest you. That’s our goal.

Do you have the health insurance coverage that’s right for you? The Medicare Annual Election Period is the perfect time to find out. Have you had a new health diagnosis? Maybe you need to change your prescription drug coverage. Or perhaps you need additional transportation, hearing, vision or dental benefits. If your needs have changed, now’s the time to evaluate your plan and explore all of your options.

At The Everett Clinic, we can connect you with a licensed insurance agent who can help you understand your options. Call us at 866-415-7402 (TTY: 711) for more information.

What is Medicare and who is it for?

Medicare is a federal health insurance program for people who are 65 years or older. It is also for those of any age with:

  • Certain disabilities lasting 24 consecutive months
  • End-stage renal disease (ESRD)
  • Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)

There are two main ways to get Medicare coverage: through Original Medicare (Plan A and Plan B) or a Medicare Advantage Plan (Part C). Some people also get additional coverage, such as Medicare prescription drug coverage (Part D), which may help cover the cost of prescription drugs and helps protect against higher costs in the future.

To learn more, visit medicare.gov.

Things to consider when choosing your Medicare coverage.

At The Everett Clinicwe want only the best for our patients. A big part of that means providing you with the information you need to make smart decisions. Here’s an easy-to-understand chart comparing the benefits of Original Medicare and Medicare Advantage: 

Original Medicare
Medicare Advantage

There’s no limit on how much you pay out-of pocket per year unless you have supplemental coverage.

Cost

Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year.

Medicare covers medical services and supplies in hospitals, doctors’ offices and other health care settings. Services are either covered under Part A or Part B.

Coverage*

Plans must cover all of the services that Original Medicare covers. Plans may offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.

You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.

Supplemental coverage

It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.

You’ll need to join a Medicare Prescription Drug Plan to get drug coverage.

Prescription drugs*

Most Medicare Advantage Plans include drug coverage.

You can go to any doctor who accepts Medicare.

Doctor and hospital choice

You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of network coverage.

You can get a snapshot of the quality of care providers (and facilities) give their patients by visiting medicare.gov.

Quality of care

The Medicare Plan Finder at medicare.gov/find-a-plan features a star rating system for Medicare plans.

Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.

Travel

Plans usually don’t cover care you get outside of the U.S.

* If you have other types of health or prescription drug coverage, check to see how it works with the type of coverage you’re considering before you make any decisions or changes.

We can connect you with a licensed insurance agent who can help you understand your options. Call us at 866-415-7402 (TTY: 711) for more information.

Our Commitment

Our team of providers and specialists at The Everett Clinic provide you with a high standard of patient care. We’re committed to be your partner in health. We encourage you to explore your available health care options to best support your needs.

  • Classes on weight loss, diabetes, and more
  • An online Patient Portal to get lab results, prescription refills and to communicate with your doctor
  • Same day appointments at many locations

You’ll also have a dedicated team of primary care doctors and specialists in more than 30 care sites, all working together to keep your health care simple and keep you feeling your best.

Additional Medicare Resources

Making the most of Medicare means having access to the latest information. Here are some additional Medicare resources to help understand your options and make the decisions that are right for you:

At The Everett Clinic, we’re here to help. To learn more, visit medicare.gov or contact your current health care plan. Call us at 866-415-7402 (TTY: 711) for more information.