Medicare The following information is an overview of Medicare provided by medicare.gov. Contact them at: 1.800.MEDICARE (800.633.4227) for general consumer information and other important telephone numbers. It is important to note that coverage and costs change yearly - look at what your coverage would be for the next year and see if the cost, coverage, quality and convenience meet your needs. Note: your local “senior center” will often provide personal counseling or “workshops” to help assist you with your Medicare options, concerns and issues.
What is MediCare?
Medicare is health insurance for:
(1) People age 65 and over
(2) People under age 65 with certain disabilities
(3) People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
www.mymedicare.gov– This website provides direct internet access to your Medicare benefits, eligibility, enrollment (including prescription drug plans) and preventive health information - 24 hours a day, 7 days a week. Visit the site, sign up, and Medicare will mail you a password to allow you access to your personal Medicare information. MyMedicare.govalso allows you to view your adjudicated claims information, access online forms and publications, and receive important messages from Medicare.
Medicare covers many of your health care needs. Today’s Medicare is working with private companies health plans provide different ways to get your health care coverage in the Medicare program. The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience and quality.
The Different Parts of Medicare
Medicare Part A (Hospital Insurance) – helps cover inpatient care in hospitals.Also helps cover skilled nursing facility, hospice and home health care. Also helps cover skilled nursing facility, hospice and home health care.
Medicare Part B (Medical Insurance) – helps cover doctors’ services, outpatient care, home health care and some preventive services.
Medicare Part C (Medicare Advantage Plans – like an HMO or PPO) – health coverage option run by private insurance companies approved by and under contract with Medicare. Includes Part A and Part B, and usually other coverage like prescription drugs.
Medicare Part D (Medicare Prescription Drug Coverage)
The Original Medicare Plan – Provides Part A and Part B coverage. This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white and blue Medicare card.
The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like co-insurance, co-payments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy (Medicare Supplement Insurance sold by private insurance companies) to cover these gaps in Medicare coverage. Additionally, you can join a Medicare Prescription Drug Plan to add drug coverage.
Medicare Advantage Plans – Medicare Part C Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.
Medicare Prescription Drug Plans Medicare Part D These stand-alone plans add prescription drug coverage to the Original Medicare Plan and to some Medicare Cost Plans and Medicare Private Fee-for-Service Plans.
The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience and quality. To compare your Medicare health plan choices, go to the Medicare Options Compare. To compare Medicare Prescription Drug Plans. Available Programs for People with Limited Income and Resources/Help Paying for Health Care Costs There are wide ranges of health care coverage choices that may help pay for some of your health care costs. These health care choices work with the benefits you have from Medicare. What you choose will affect how much you pay, what benefits you have, which doctors you can see, and other things that may be important to you. For more information about programs that may help pay for some of your health care costs, please call 1.800.MEDICARE (or their website).
Programs of All-Inclusive Care for the Elderly (PACE) Pace combines medical, social, long-term care services and prescription drug coverage for frail elderly and disabled people.This program allows people who need a nursing home-level of care to remain in the community.
Medicare Information Overview Prescription Drug Coverage (Part D)
What is Medicare prescription drug coverage? Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs.
Who can get Medicare prescription drug coverage? Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.
When can I get Medicare prescription drug coverage? You may sign up from November 15th to December 31st. Your coverage will start January 1st of the following year. If you don't sign up when you are first eligible, you may pay a penalty. Enrolling by December 8th can help ensure you can use your coverage as soon as you need it after it starts.
How does Medicare prescription drug coverage work? Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.
Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you.
Like other insurance, if you join, generally you will pay a monthly premium, which varies by plan and a yearly deductible.
You will also pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at: (800) 772.1213 TTY: (800) 325.0778 or visiting: www.socialsecurity.gov.
Why should I get Medicare prescription drug coverage? Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.
What if I have a limited income and resources? There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help. Medicare will pay for almost all of their prescription drug costs. You can apply or get more information about the extra help by calling Social Security at: (800) 772.1213 or TTY: (800) 325.0778 or visit: www.socialsecurity.gov.