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Medicare Questions

Frequently asked questions

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We know you have questions about Medicare. Here we’ve answered some of the questions you ask most often. Simply click on the question below to see its answer.

General 

  1. What is Original Medicare? 
  2. Who is eligible for Medicare? 
  3. How do I apply for Medicare? 
  4. What are the basic parts of the Medicare program? 
  5. What is Medicare Supplement or Medigap? 
  6. When can I switch Medicare health plans?
  7. What’s the difference between traditional Medicare and Medicare prescription drug coverage?
  8. Does my Medicare Advantage plan cover hospice? 
  1. What is Original Medicare?

    Original Medicare is a fee-for-service coverage managed by the federal government. It covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are covered under Part A or Part B, usually with a cost for each service. Many factors affect what you pay, including:

    • Whether or not your doctor accepts Medicare.
    • The type of care you need and how often you need it.
    • Whether you get services or supplies not covered by Medicare.
    • Whether you have other insurance that works with Original Medicare (like a Medicare Supplement or Medigap plan).

    For detailed information about Medicare-covered items and services, visit http://www.Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week (TTY: 1-877-486-2048 for the hearing impaired).

    You’ll stay in Original Medicare unless you choose to join a Medicare Advantage plan or other Medicare health plan through a private insurance company.

     

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  2. Who is eligible for Medicare?

    You are eligible for Medicare if you:

    • Reach age 65 and are entitled to monthly Social Security benefits.
    • Are age 65 or older and have a spouse entitled to Social Security benefits, even if you are not.
    • Are age 65 or older and are the widow or widower of someone who was entitled to Social Security benefits.
    • Are under age 65 and have received Social Security disability benefits for at least 24 months.
    • Are entitled to Social Security benefits and have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

     

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  3. How do I apply for Medicare?

    You can sign up for Medicare during your Initial Election Period (starting three months before the month of your 65th birthday the actual month of your birthday, and for three months after your birthday). However, other rules apply if you are:

    • Collecting Social Security benefits
    • Still working
    • Eligible for Medicare because of a disability

    For more information, contact Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) Monday through Friday, 7 a.m. to 7 p.m., or visit the Social Security Administration website at http://www.ssa.gov.

     

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  4. What are the basic parts of the Medicare program?

    There are 4 Parts to Medicare - A, B, C & D

    • Part A (Hospital Insurance)

    • Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

    • Part B (Medical Insurance)
      • Covers certain doctors' services
      • Outpatient care
      • Medical supplies
      • Preventive services

    • Part B also covers some physical and occupational therapist services and some home health care. Most people pay a monthly premium for Part B, which is deducted from your Social Security check.

    • Part C (Medicare Advantage Plans): A Medicare health plan offered by a private company that contracts with Medicare to provide your Part A and Part B benefits. There are different types of Part C plans, including:
      • Health Maintenance Organizations (HMOs)
      • Preferred Provider Organizations (PPOs)
      • Private Fee-for-Service Plans (PFFS)
      • Special Needs Plans (SNPs)
      • Medicare Medical Savings Account Plans(MSAs)

    • Medicare Advantage plans cover Medicare services through the plan - they’re not paid for under Original Medicare. Most Medicare Advantage plans offer prescription drug coverage. Many provide additional benefits beyond those covered under Part A and B.

    • Part D (Medicare prescription drug plans): Coverage for prescription drugs only. You must enroll in a plan to get prescription drug coverage. Medicare prescription drug plans are contracted with the federal government and offered through private insurance companies.

    • For more information about Medicare, visit http://www.Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week (TTY: 1-877-486-2048 for the hearing impaired). Another useful resource is the Centers for Medicare & Medicaid Services (CMS) publication Medicare and You. This publication is located at http://www.Medicare.gov/publications,

     

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  5. What is Medicare Supplement or Medigap?

    Medicare Supplement, or Medigap, coverage is offered by private insurance companies to help pay for certain benefits not covered by Original Medicare (Parts A and B). New Medicare Supplement policies no longer cover prescription drugs.

     

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  6. When can I switch Medicare health plans? 

    Generally, you can only make changes during the Annual Election Period (October 15 through December 7) if you already made your initial Medicare selection. During this time, you can select a new Medicare health and/or prescription drug plan for the next calendar year.

    You can’t make any other changes during the year unless you’re newly becoming eligible for Medicare or meet certain special exceptions and receive a Special Election Period (SEP). These exceptions include moving out of the plan's service area or losing your employer coverage.

     

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  7. What's the difference between traditional Medicare and Medicare prescription drug coverage?

    Original Medicare (Parts A and B) helps cover hospitalization, outpatient medical services, and limited prescription drug coverage. Part D provides individuals with prescription drug benefit coverage only.

     

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  8. Does my Medicare Advantage plan cover hospice?

    You may elect to receive care from any Medicare-certified hospice program. Original Medicare will pay the hospice provider for the Medicare covered services you receive. Your hospice doctor can be a network provider or an out-of-network provider.

    Original Medicare will still pay for benefits covered by Medicare Part A or B for any health problems that aren't part of your terminal illness and related conditions.

    • You'll remain a member on our plan and services that are not covered by Original Medicare (like Dental and Vision benefits) will be covered through our plan.
    • Your plan will also cover one hospice consultation service for a terminally ill person who hasn't elected the hospice benefit.


    Refer to https://www.medicare.gov/Pubs/pdf/02154.pdf for more detailed information.

     

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Page last updated: February 10, 2016