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Medicare
Am I covered once I have Part A and Part B?
Part A (Hospital Insurance) helps cover: • Inpatient care in a hospital • Inpatient care in a skilled nursing facility (not custodial or long-term care) • Hospice care • Home health care • Inpatient care in a religious nonmedical health care institution You can find out if you have Part A by looking at your red, white, and blue Medicare card. If you have it, it will be listed as “PART-A” and will have an effective date. If you have Original Medicare, you’ll use this card to get your Medicare-covered services. If you join a Medicare Advantage Plan or Medicare health plan, in most cases, you must use the card from the plan to get your Medicare-covered services
Medicare Part B (Medical Insurance) helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services. You can find out if you have Part B by looking at your red, white, and blue Medicare card. If you have it, it will be listed as “PART-B” and will have an effective date. Medicare may cover some services and tests more often than the time frames listed if needed to diagnose or treat a condition.
Where can I find a list of coverages?
You can order or download "Medicare and You" at medicare.gov/Publications/
This book will also have more detailed information on how Medicare works.
Part B Premium.
It is Important to note that in order to get Original Medicare Part B, you will have to pay Part B premium either yourself, through Social Security, or other options such as a Union Retirement Plan/Pension or Medicaid if you qualify. It is not part of private insurance companies costs so this premium will not be included in quotes for Medigap (Medicare Supplement) or Advantage (Part-C) plans.
Medicare Supplements
Medicare Supplement Policies
Medicare supplement plans (also called Medigap) are private health insurance specifically designed to supplement and work only with Original Medicare. Private insurance companies sell Medicare supplement plans. Medicare supplement plans help pay some of the coinsurance, copayments and deductibles (“gaps”) in Original Medicare. They may also cover certain medical services Medicare doesn’t cover. People who are enrolled in Original Medicare and buy a Medicare supplement plan will generally have 100 percent of their Medicare-approved health care costs covered (depending on the plan they choose). Medicare supplement plans aren’t Original Medicare or a Medicare Advantage plan because they’re not a way to get Medicare benefits. Medicare supplement plans are identified by letters (such as Plan G) except in Massachusetts, Minnesota and Wisconsin
. • Each Medicare supplement plan must offer the same basic benefits, no matter which insurance company sells it.
• Usually the differences between Medicare supplement policies sold by different insurance companies are the cost, underwriting criteria, extra services (value-added) and customer service.
• Medicare supplement insurance companies must follow federal and state laws.
• A Medicare supplement plan only covers one person. If a married couple wants Medicare supplement coverage, they must buy separate Medicare supplement plans.
Medicare Advantage
What is an Advantage (Part C) Plan?
Part C (Medicare Advantage)
A Medicare Advantage Plan is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. However, many plans offer out-of-network coverage, but sometimes at a higher cost. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
What are 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 (SNPs).
• HMO Point-of-Service (HMOPOS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
• Medical Savings Account (MSA) Plans: These plans combine a highdeductible health plan with a bank account that the plan selects. The plan 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. MSA Plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan. For more information on MSA Plans, visit Medicare.gov. To find out if an MSA Plan is available in your area, visit Medicare.gov/plan-compare.
Medicare Advantage Plans cover almost all Medicare Part A and Part B benefits
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover almost all of the medically necessary services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
Plans can offer extra benefits
Most Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-thecounter drugs, adult day-care services, and other health-related services that promote your health and wellness. Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check with us to see what Plans in our area offer.
Medicare Advantage Plans must follow Medicare’s rules
Medicare pays a fixed amount for your coverage each 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 doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year. Remember, you have the option each year to keep your current plan, choose a different plan, or switch to Original Medicare. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider. You generally can’t change plans during the year if this happens.
Even though the network of providers may change during the year, the plan must still provide access to qualified doctors and specialists. Your plan will make a good faith effort to provide you with at least 30 days’ notice that your provider is leaving your plan so you have time to choose a new provider. Your plan will also help you choose a new provider to continue managing your health care needs.