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Mike Mathweg

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Medicare Coverage Options

Step one |

First, you need to enroll in Original Medicare

Provided by the federal government

Part A

Helps pay for hospital stays and inpatient care

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Part B

Helps pay for licensed provider visits and outpatient care

Learn More

Step two |

Now, you may look at additional coverage options

Offered by private insurance companies

Option 1

Medicare Supplement Insurance (Medigap)

Helps pay some out-of-pocket costs not paid by Original Medicare

  • Does not include prescription drug coverage; a Medicare Part D plan can add prescription coverage.
Learn More

Option 2

Medicare Advantage (Part C)

Combines Original Medicare Part A & Part B coverage in one plan

  • Usually includes Part D prescription drug coverage
  • May offer additional benefits such as vision and dental coverage.
Learn More

Resources

Helpful Contacts
Medicare Helpline

Call for questions about Medicare.
1-800-MEDICARE (1-800-633-4227),
TTY 1-877-486-2048

Social Security Administration

Get answers to questions about Medicare eligibility, social retirement benefits, or disability benefits.
1-800-772-1213, TTY 1-800-325-0778
ssa.gov/benefits/medicare

medicare.gov

The Medicare website provides information and offers online tools to search Medicare plans.

medicaid.gov

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Learn more at their site.

National Hospice and Palliative Care Organization

Learn about hospice care and hospice programs where you live. Your licensed provider or other health care professional may also be able to help you find local services.
nhpco.org

Administration on Aging

Discover local, state and community-based organizations that serve older adults and their caregivers.
1-800-677-1116, TTY 711
eldercare.acl.gov

medicaremadeclear.com

Watch videos, sign up for a newsletter, find helful tools and resources to get answers to your Medicare questions.

Me

I am always available to help answer any questions that you may have. If I don’t know that answer, I will be able to get the answer for you. Send your questions here.

Download the Medicare Guide from Medicare Made Clear

I've got you covered

Finding the right insurance product can be overwhelming. I am here to make it easy and to be your dependable resource.

Medicare Advantage

Medicare Advantage plans are offered by private companies. Many include prescription coverage.


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Medicare Supplement

Medicare Supplement, Medigap, insurance are offered by private companies. They are designed to cover costs not paid by Original Medicare though they do not include prescription coverage

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Medicare Part D

Medicare Part D is the federal government’s prescription drug program.



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Individual Health Insurance

No one wants to plan to get sick or hurt, but being prepared for it protects you from very high expenses.


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Long Term Care

At some point as we age, their is a high likelihood we will need some type of medicare or personal care. Long Term care plans provide a variety of services which help meet medical and non-medical needs.

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Final Expense

Get peace of mind for yourself and your loved ones. Final Expense options can offer your family comfort and peace of mind.


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I'm here to help

Whether you have questions about Medicare, need guidance on plan options, or just want to talk through your choices, I’m here to make it simple.

Contact Me

  • Relentless Consulting
  • 1100 Bellevue Way NE
  • Ste 8A-692
  • Bellevue, WA 98004

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Ready to get started?

If you are ready to get started, click one of the links below. You can either complete a quick survey so I can gather your information, OR schedule a time with me.
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I do not offer every plan available in your area. Any information provided is limited to those plans that I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

Number of plans offered: 105
Number of organizations represented: 9

Final Expense

Final Expense Insurance is a small whole life policy designed to cover end-of-life costs

Services covered:
  • Funeral and burial or cremation expenses
  • Medical bills not covered by other insurance
  • Outstanding debts (credit cards, legal feeds, etc.)
Policy Structure:
  • Whole life insurance with a modest death benefit (typically $5,000-$50,000)
  • Premiums are generally affordable and fixed for life
  • No medical exam required, easy to qualify
  • Funds can be used for any purpose, not just funeral costs
Pros:
  • Accessible for seniors and those with health issues
  • Provides peace of mind by removing financial burden on loved ones
  • Builds small cash value over time
Cons:
  • Coverage amounts are limited compared to traditional life insurance
  • Premiums may be higher relative to the small benefit

Long Term Care

Long Term Care insurance helps cover the costs of extended care services when you can no longer perform basic daily activities independently.

Services Covered:
  • Home health care
  • Assisted living facilities
  • Nursing home care
  • Adult day care
  • Respite care for caregivers
  • Memory care for conditions like dementia

Policy Structure:
  • Pays a daily or monthly benefits
  • Coverage typically lasts 2-5 years, though some policies offer lifetime benefits
  • Waiting/elimination period before benefits begin (commonly 90 days)
  • Optional inflation protect to keep up with rising costs
Pros:
  • Protects savings and assets from being depleted by care costs
  • Provides access to higher-quality facilities not covered
  • Guaranteed renewable as long as premiums are paid
Cons:
  • Premiums can be expensive
  • Benefits are capped; if care exceeds limits, you must pay out-of-pocket
  • Policies vary widely

Individual Health Insurance

Affordable Care Act (ACA) individual health insurance plans are designed to provide comprehensive coverage for essential health needs

Key Features:

  • Guaranteed Coverage: Insurers cannot deny based on pre-existing conditions.
  • Standardized Benefits: All ACA plans must cover a set of Essential Health Benefits.
  • Financial Assistance: Premium tax credits and cost-sharing reductions may lower costs based on income.

Medicare Part D

Medicare Part D plans provide coverage for prescriptions and some vaccines

Coverage includes:

  • Drugs most commonly prescribed for Medicare beneficiaries as determined by federal standards
  • Specific brand name drugs and generic drugs included in the plan’s formulary (list of covered drugs)
  • Most commercially available vaccines not covered by Medicare Part B

Medicare Part D plans typically do not cover:

  • Drugs not listed  on a plan’s formulary
  • Drugs prescribed for anorexia, weight loss or weight gain
  • Prescriptions for fertility and sexual or erectile dysfunction (ED)
  • Prescriptions for cosmetic purposes or hair growth
  • Prescription vitamins and minerals
  • Non-prescription drugs (e.g. over-the-counter medications)


* Beneficiaries cannot be enrolled in both a Medicare Part D plan and a Medicare Advantage plan at the same time. While some Medicare Advantage plans have Prescription Drug Coverage, others do not.

Medicare Advantage

Medicare Advantage (Part C) plans combine Part A and Part B benefits

Medicare Advantage plans are offered by private insurance companies approved by Medicare.

In addition to Part A and Part B benefits, many plans offer:
  • Part D prescription drug coverage
  • Routine hearing exams and hearing aids
  • Routine dental care
  • Routine eye exams, eyeglasses or contract lenses
  • Wellness benefits such as gym memberships


* Benefits vary by plan and could include other extra benefits such as transportation to medical appointments and credits to buy health products.

Medicare Advantage plans often offer $0 premiums

Some plans may charge premiums, deductibles, copays or coinsurance and plan premiums can change each year.

You will continue to pay your Part B premium directly to Medicare, and you Part A premium too, if you have one. Copay amounts may vary based on the coverage item or service and deductibles may be applied to drug benefits and not medical benefits when a plan covers both. Coinsurance may apply for some services.

Pros:
  • Lower Premiums
  • Out-of-Pocket Maximum spending cap
  • Bundled Coverage
  • Extra Benefits
  • Coordinated Care
Cons:
  • Network Restrictions
  • Geographic Limitations
  • Variable Costs
  • Prior Authorizations
  • Less Flexibility for Travel

Medicare Supplement

Medicare Supplement insurance (Medigap) plans can help pay some of the out-of-pocket costs not paid by Parts A & B

Plans are offered by private insurance companies but are standardized by the federal government.

All include full or partial coverage for:
  • Part A hospital coinsurance
  • Part B coinsurance or copays
  • Cost of blood transfusions (first 3 pints)
  • Costs for 365 extra hospital days
  • Hospice care coinsurance
Some may also help pay for:
  • Part A deductible
  • Part B deductible*
  • Foreign travel emergency care up to plan limits
  • Part A skilled nursing facility care coinsurance


*Not available for those newly eligible for Medicare Part A in 2020 or beyond.

Pros:
  • Lower Out-of-Pocket Costs compared to just Original Mediare
  • Predictable Healthcare Expenses
  • Nationwide Provider Access
  • Emergency Foreign Travel Coverage
  • Guaranteed Renewable
Cons:
  • Additional Monthly Premiums
  • No Prescription Drug Coverage
  • Limited Enrollment Windows
  • No Extra Ancillary Benefits
  • Higher Costs for Some

Medicare Part B

Part B helps pay for covered care at a clinic or at a hospital as an outpatient

Coverage includes:

  • Doctor visits, including in the hospital
  • Annual Wellness Visit
  • Ambulatory Surgery Center (ASC) services
  • Ambulance and emergency room services
  • Skilled nursing services
  • Preventive services, such as flu shots or mammograms
  • Clinical laboratory services, such as blood and urine tests
  • X-rays, MRIs, CT scans, EKGs and some other diagnostic tests
  • Some health programs, such as smoking cessation, obesity counseling and cardiac rehab
  • Physical therapy, occupational therapy and speech-language pathology services
  • Diabetes screenings, diabetes education and certain diabetes supplies
  • Mental health care
  • Durable medical equipment for use at home, such as wheelchairs and walkers
  • Telehealth visits

Not all providers offer virtual care. Some services may have limitations. Preventive services and screenings are covered on set schedules, such as a yearly flu shot. Other covered services and supplies must be medically necessary to diagnose or treat a disease or condition.

Medicare Part A

Part A helps pay for covered hospital stays and most of the inpatient services

Coverage includes:

  • A semi-private room
  • Hospital meals
  • Skilled nursing services
  • Care in special units, such as intensive care
  • Drugs, medical supplies and medical equipment used during an inpatient stay
  • Lab tests, X-rays and medical equipment as an inpatient
  • Operating room and recovery room services
  • Some blood transfusions in a hospital or skilled nursing facility
  • Inpatient or outpatient rehabilitations services after a qualified inpatient stay
  • Part-time, skilled care for the homebound after a qualified inpatient stay
  • Hospice care for the terminally ill, including medications to manage symptoms and control pain