MEDICARE BASICS

What is Medicare?
Medicare is health insurance for people age 65 or older and people under 65 with certain disabilities

The different parts of Medicare help cover specific services:
Medicare Part A: Hospital Coverage
Medicare Part B: Medical Insurance
Medicare Part C: Medicare Advantage Plans
Medicare Part D: Prescription Drug Plans

Medicare Part A
Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.

How Much Does Part A Cost?
Most people don’t pay a Part A premium because they paid Medicare taxes while working. This is called "premium-free Part A."
If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:
You're 65 or older, and you have (or are enrolling in) Part B, and you meet the citizenship or residency requirements.
You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you’re under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)
In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

•How Do I Get Part A?
Some people automatically get Part A. Learn how and when you can sign up for Part A.

•What Does Part A Cover?
To find out if Part A covers something specific, visit Your Medicare Coverage. In general, Part A covers:
◦Inpatient care in hospitals (such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals)

◦Inpatient care in a skilled nursing facility (not custodial or long term care)
◦Hospice care services
Home health care services
◦Inpatient care in a Religious Nonmedical Health Care Institution

Medicare Part B
Part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

•How Much Does Part B Cost?
If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.

•How Do I Get Part B?
Some people automatically get Part B. Learn how and when you can sign up for Part B.

•What Does Part B Cover?
To find out if Part B covers something specific, visit Your Medicare Coverage. Part B covers two types of services: ◦Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services -  Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.


Medicare Advantage (Part C)
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

Different Types of Medicare Advantage Plans
◦Health Maintenance Organization (HMO) Plans

◦Preferred Provider Organization (PPO) Plans
◦Private Fee-for-Service (PFFS) Plans
◦Special Needs Plans (SNP) There are other less common types of Medicare Advantage Plans that may be available: HMO Point of Service (HMOPOS) Plans- An HMO plan that may allow you to get some services out-of-network for a higher cost.

•Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

•How Much Does a Medicare Advantage Plan Cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:
◦Whether the plan charges a monthly premium.

◦Whether the plan pays any of your monthly Part B premium.
◦Whether the plan has a yearly deductible or any additional deductibles.
◦How much you pay for each visit or service (copayments or coinsurance).
◦The type of health care services you need and how often you get them.
Whether you follow the plan’s rules, like using network providers.
◦Whether you need extra benefits and if the plan charges for them.
◦The plan’s yearly limit on your out-of-pocket costs for all medical services.

•What Does a Medicare Advantage Plan Cover?
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

•How to Join a Medicare Advantage Plan
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan's Web site. Medicare also has information on quality to help you compare plans.

•A Few Extra Things You Should Know about Medicare Advantage Plans
You can only join a plan at certain times during the year outside of your Open enrollment period. In most cases, you're enrolled in a plan for a year. As with Original Medicare, you still have Medicare rights and protections, including the right to appeal. Check with the plan before you get a service to find out whether they will cover the service and what your costs may be. You must follow plan rules, in some cases, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan before you join. These rules can change each year.


Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty. To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.


There are two ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Both types of plans are called “Medicare drug plans.” In either case you must live in the service area of the Medicare drug plan you want to join.


Brief description provided - Medicare.gov. For detailed information on Medicare benefits, visit medicare.gov.

Things to Consider

Cost
Coverage
Doctor and hospital choice
Prescription drugs
Quality of care
Convenience

Medicare Choices

1. Original Medicare
Option - Medicare Supplement
Option - Part D (prescription drugs)
2. Medicare Advantage Plan (like HMO or PPO)
Option - Part D