Original Medicare
The federal program structure that includes Medicare Part A and Part B. It does not automatically include every healthcare cost or prescription-drug coverage.
Health & Medicare Education
You Have Health Insurance. But Do You Understand How It Actually Works?
Sasha’s role on this site is education and consulting—helping you understand common terms, costs, networks, coverage gaps, and Medicare basics.
The Language of Health Coverage
Six terms that can change what you pay.
Your plan documents control the details. These plain-language definitions are a place to begin.
- Deductible
- The amount you generally pay for covered services before your plan begins paying according to its terms. Some services may be treated differently.
- Copay
- A set amount you may pay for a covered service or prescription, depending on the plan.
- Coinsurance
- Your percentage share of the allowed cost for a covered service, often after the deductible is met.
- Out-of-Pocket Maximum
- The most you generally pay in a plan period for covered, in-network services counted under the plan. Premiums and some costs may not count.
- In-Network
- Providers or facilities that participate in your plan’s network under negotiated terms.
- Out-of-Network
- Providers outside your plan’s network. Coverage may be limited or cost more, and some plans may not cover non-emergency care out of network.
Coverage Gaps
The card in your wallet is only the beginning.
Look beyond “covered” and ask what you may owe, where you can receive care, and which rules apply before a service or prescription.
- Does the deductible apply?
- What copay or coinsurance applies?
- Is the provider in-network?
- Is prior authorization required?
- Are there exclusions, limits, or non-covered services?
- What is my maximum financial exposure?
Medicare Education
Start with the pieces. Then ask how they work together.
Medicare education on this site is primarily for adults age 65+ and for family members helping them understand coverage concepts.
Medicare Part A
Often described as hospital insurance. It may help cover eligible inpatient hospital care and certain other services under program rules.
Medicare Part B
Often described as medical insurance. It may help cover eligible physician, outpatient, preventive, and other medical services.
Medicare Advantage / Part C
Medicare-approved private-plan options that provide Part A and Part B benefits and may include additional benefits or drug coverage, subject to the plan.
Medicare Part D
Prescription-drug coverage offered through Medicare-approved private plans. Formularies, pharmacies, costs, and coverage rules vary.
Medicare Supplement / Medigap
Private insurance designed to help with certain cost-sharing gaps in Original Medicare, subject to eligibility, plan standards, and availability.
Medicare Questions Checklist
Take these questions into your next coverage conversation.
The answers depend on your specific coverage, service area, providers, prescriptions, and plan rules.
- Are my doctors in-network?
- Are my prescriptions covered?
- Which pharmacies should I use?
- What will I pay for specialists?
- What happens if I am hospitalized?
- What is my out-of-pocket exposure?
- Does my coverage travel with me?
- Are referrals required?
- Is prior authorization required?
Education & consulting
Bring the question you wish someone would explain clearly.
Sasha currently provides Medicare education and consulting through this website. This page does not present Sasha as selling Medicare plans.