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Medicare Basics: Parts A, B, C & D - YouTube
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(upbeat music)
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- Hi, my name is Carol Carstensen.
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I'm part of the Medicare Made Clear team.
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And I know from trying
to learn about it myself,
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just how much there is
to know about Medicare.
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It can be kind of overwhelming at times,
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even if you've been at it for years.
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So today, I'm gonna go
over the basics of Medicare
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because a strong foundation in the basics
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is gonna help you understand your choices
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and make better Medicare
decisions for yourself.
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We'll start at the beginning
and talk a little bit about
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what Medicare is and who can get it.
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Then, we'll talk about
the parts of Medicare,
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what they cover, what they cost,
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and then we'll go into how
to put those parts together
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to come up with coverage
that works for you.
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So, let's get started.
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Medicare is a federal
health insurance program
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for people 65 and older
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and others who have
qualifying disabilities.
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You also need to be a
United States citizen
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or a legal resident.
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If you're a legal resident,
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you need to have lived in this country
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for at least five years in a row,
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including the five years just
before you enroll in Medicare.
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Another important thing about Medicare
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is its individual insurance.
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Meaning every individual person
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needs to qualify for it
themselves, enroll in it
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and choose coverage for themselves.
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This can be different
from what you're used to
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if you've had a family health
plan through an employer,
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for example.
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Government-sponsored Medicare
is made up of two parts,
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Part A and Part B.
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Each part covers certain
health care services.
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The two together are often
called Original Medicare
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or sometimes traditional Medicare.
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There's also a Part C and a Part D,
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and Medicare supplement insurance.
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And we'll get to those in a little bit.
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So, let's start with Part A.
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Part A is hospital insurance.
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It covers inpatient care
when you're in the hospital
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or a skilled nursing facility.
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It covers your room, your meals,
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your nursing services when
you're in the hospital,
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any equipment or supplies
that are used in your care,
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operating room, whatever
the needs are that you have
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while you're in the hospital
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or in a skilled nursing facility.
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Medicare Part B is medical insurance.
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It covers your doctor visits
or your doctor services,
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even when you're in the hospital.
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Other things covered by Part B include
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care when you're in an outpatient facility
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like the clinic or the
emergency room, for example,
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ambulance services if you need
to go to the emergency room,
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preventive care services like flu shots,
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medical devices that
you might use at home,
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such as a wheelchair.
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Original Medicare, again,
has Part A and Part B,
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and it does come with some costs.
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Those costs can include
premiums, deductibles, copays,
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and coinsurance.
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Now, let's start with Part A.
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Part A, in fact, is premium
free for most people.
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If you've worked and pay
taxes or your spouse has
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for at least 10 years, then
you get Part A premium free,
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otherwise you would have to pay a premium.
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Other costs for Part
A include a deductible
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and some copays and coinsurance.
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But importantly, you only pay for Part A
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when you're actually
receiving Part A services,
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such as when you go in the hospital.
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So, Medicare Part B does
come with a premium.
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And that will be deducted out
of your Social Security check
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if you receive Social Security.
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Otherwise you'll need to
pay it directly to Medicare.
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Other costs with Part B include
some copays, a deductible
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and some coinsurance.
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For most services, you
pay 20% coinsurance,
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and that means you pay 20% of
the Medicare-approved amount
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for that service and Medicare pays 80%.
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So, we've talked about Original Medicare
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Part A and Part B, what they
cover and what they cost,
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but they don't cover everything.
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Neither Part A nor Part B
covers prescription drugs,
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for example, dental, or
vision, or hearing care.
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This is where Part C, Part D
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and Medicare supplement insurance come in.
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They offer you more coverage options.
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Let's start with Part C.
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Part C is Medicare Advantage.
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Medicare Advantage plans are offered
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by private insurance companies.
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They cover everything that
Original Medicare covers,
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all of your Part A benefits
and Part B benefits.
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In addition, most plans will include
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prescription drug coverage
and additional benefits
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like dental and vision coverage.
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The costs for a Medicare Advantage plan
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might include a premium or it might not.
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There are some plans
that have $0 premiums.
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Other costs would include
copays for services you receive
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and sometimes the coinsurance.
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Another important thing to know
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about Medicare Advantage plans
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is that they are required by Medicare
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to set an annual out-of-pocket limit.
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This out-of-pocket limit is like
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built-in financial protection,
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because if you reach that limit,
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the plan would pay all of your costs
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for the rest of that year.
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There may be many Medicare
Advantage plans offered
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in a region, or a state, or a county,
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and each one will have its
own coverage and cost terms.
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Now, let's talk about Medicare Part D.
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Medicare Part D is
prescription drug coverage.
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You can get prescription
drug coverage in two ways,
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either through in the
Medicare Advantage plan,
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like we just talked about,
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or through a stand-alone Part D plan.
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You can always remember
prescription drug plans and Part D
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by thinking D is for drugs.
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Medicare requires that Part
D plans cover all the types
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or classes of drugs that are normally used
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by Medicare beneficiaries.
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Every plan has a formulary
or a list of covered drugs.
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So, when you're choosing
a Medicare Part D plan,
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it's really important to
look at those formularies
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and make sure that the drugs that you take
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are on those lists.
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Costs for a Medicare Part D
plan vary from plan to plan.
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But it usually includes a premium,
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and you'll probably pay a copay
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when you fill a prescription.
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What you pay in copays,
again, depends on the plan
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and also the formulary.
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Every plan places certain
drugs on what they call tiers,
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or levels, of a formulary
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and the level determines what you pay
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at the pharmacy counter.
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Usually, the higher the level
or tier, the more you'll pay.
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Costs for Medicare Part D
will vary from plan to plan,
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but most plans have a pharmacy network.
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And if you fill your
prescriptions within that network,
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you're going to get the best
price for that prescription.
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Medicare supplement insurance
is also called Medigap,
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and it's just what it sounds like.
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It supplements Medicare.
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Medicare supplement plans help pay
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some of the out-of-pocket costs
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that come with the Original
Medicare Part A and Part B.
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Medicare supplement
plans are standardized,
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they're labeled from A through N.
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There's 10 different plans with
varying levels of coverage.
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So, each Medicare supplement
plan that has the same letter
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offers exactly the same coverage.
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However, plans may differ
in what they charge.
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So, a Plan G, for example,
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in one state may be a different price
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from Plan G in another state.
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The main purpose of a
Medicare supplement plan
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is to cover the costs that
come with Original Medicare
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Part A and Part B.
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However, some Medicare
supplement plan providers
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do offer additional programs
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that can provide discounted
services for dental,
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or hearing, or other health care services.
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Medicare parts and plans can work together
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in different combinations to offer you
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the coverage you need.
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It really comes down to two scenarios.
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You can keep Original
Medicare Part A and Part B
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and decide to add
prescription drug coverage
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and/or a Medicare supplement plan
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Or you can choose a Medicare
Advantage plan instead,
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which encompasses all of
the coverage in one plan.
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People often ask, how do I
know what's right for me?
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What Medicare plan should I choose?
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Well, that choice is personal
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because your health needs are personal
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and each person needs to make
a decision for themselves.
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There are a few things to
think about as you look at
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Medicare plans and coverage in general.
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One, would you like to
have additional benefits
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like dental or vision?
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If so, then a Medicare Advantage plan
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might be a better choice
because they offer these options
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whereas Original Medicare doesn't.
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Two, would you prefer to
have lower monthly premiums
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and pay as you go, so to speak,
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when you go to the doctor with the copays.
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Or would you prefer to
have higher premiums
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and fewer copays or
out-of-pocket expenses?
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Number three, do you have specific doctors
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or providers you'd like to see,
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or do you travel frequently?
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If you do, Original Medicare
might be a good choice for you
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because every provider in
the United States is covered.
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Medicare Advantage plans
often have a provider network
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and you need to choose providers
from within the network
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to get the plan's best prices.
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So, there you have it,
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that's the basics of Medicare.
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And if there's just one thing
that you take away from today,
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I hope it's this:
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you get to choose.
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You get to choose Medicare coverage
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that fits your health needs, your budget
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and your lifestyle.
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If you need more information
about Medicare basics
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or other Medicare topics, please visit us
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at MedicarMadeClear.com,
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and follow us on Facebook
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for answers to your Medicare questions
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and regular updates on Medicare topics.
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Thanks so much for listening.
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(upbeat music)
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