Medicare Basics

What is Medicare?

Medicare is the federal health insurance program for people age 65 and older. The program also provides insurance for people under 65 with certain disabilities and people of all ages with End-Stage Renal Disease.

VIDEO: Learn the ABC’s of Medicare

Medicare — often called Original Medicare — consists of two parts:

  • Part A: Coverage for hospital stays, home health services, and hospice care.
  • Part B: Coverage for doctors’ services, outpatient care, and medical equipment.

But Original Medicare doesn’t pay for everything. That’s where a Medicare Advantage plan can help.

Medicare Part A

  • Provides coverage for hospital stays, home health services, and hospice care
  • Part of what’s called “Original Medicare”

 

Medicare Part B       

  • Provides coverage for doctors’ services, outpatient care, and medical equipment.
  • Part of what’s called “Original Medicare”

 

Medicare Part C

  • Also known as a Medicare Advantage plan
  • Includes everything covered under Medicare Part A, Part B, and Part D in one plan, plus added benefits like vision and dental coverage
  • MedStar Medicare Choice is a Medicare Advantage plan

 

Medicare Part D

  • Provides prescription drug coverage
  • Not a part of “Original Medicare,” Part D must be purchased separately unless you enroll in a Medicare Advantage plan like the MedStar Medicare Choice plans.

 

What is Medicare Part A?

Medicare Part A is a part of Original Medicare. Think of Medicare Part A as hospital insurance that covers services including

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice
  • Home health services

Medicare Part A Eligibility

You are eligible for Medicare Part A if you:

  • Are 65 years or older
  • Are a citizen or permanent resident of the United States
  • You or your spouse worked for at least 10 years in Medicare-covered employment

Note: You may also be eligible for Medicare Part A coverage if you have a disability or have been diagnosed with End-Stage Renal Disease.

To learn more about Medicare Part A and how to enroll, visit the federal government’s Medicare Eligibility Tool.

When you are eligible, you will be automatically enrolled in Medicare Part A if you already receive benefits from Social Security or from the Railroad Retirement Board (RRB). If you aren’t getting Social Security benefits or are still working, you may need to sign up for Part A, even if you are eligible to receive Part A at no cost.

You must have Original Medicare Part A coverage before you can enroll in a MedStar Medicare Choice plan. Members of a Medicare Advantage plan continue to pay the Original Medicare Part B premium in addition to any other premiums associated with the Medicare Advantage plan.

MedStar Medicare Choice plans include coverage for everything covered under Medicare Part A.

 

What is Medicare Part B?

Like Medicare Part A, Medicare Part B is part of Original Medicare. It is purchased from the federal government, and most people pay a monthly premium. This premium is usually deducted from your Social Security check. Medicare B covers such services as

  • Visits to a primary care physician or specialist’s office
  • Preventive services, such as flu shots and mammograms
  • Lab and X-ray services
  • Ambulance services
  • Clinical research
  • Outpatient surgery
  • Durable Medical Equipment (DME)
  • Outpatient physical therapy
  • Mental health care
  • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Certain types of outpatient care, such as comprehensive annual physical exams and routine vision and dental services, are not covered by Medicare Part B.

Medicare Part B Eligibility

You are eligible for Medicare Part B if you

  • Are 65 years or older
  • Are a citizen or permanent resident of the United States
  • You or your spouse worked for at least 10 years in Medicare-covered employment

Note: You may also be eligible for Medicare Part B coverage if you have a disability or have been diagnosed with End-Stage Renal Disease.

To learn more about Medicare Part B and how to enroll, please visit the federal government’s Medicare Eligibility Tool.

You must have Original Medicare Part B coverage before you can enroll in any of the MedStar Medicare Choice plans. You must continue to pay your Medicare Part B premium.

MedStar Medicare Choice plans include coverage for everything covered under Medicare Part B.

 

What is Medicare Advantage (Part C)?

Medicare Part C is also known as Medicare Advantage. It is a type of Medicare healthcare coverage offered by private companies. As healthcare costs continue to rise, Original Medicare may not offer you enough coverage. Without the added protection of a Medicare Advantage plan, you could end up paying higher medical expenses out of your own pocket, especially if your health status requires specialists, extended hospital stays, and expensive prescription drugs.

MedStar Medicare Choice is a Medicare Advantage plan.

With Medicare Advantage, you are covered:

  • For all the services normally covered under Original Medicare (Medicare Part A and Part B)
  • For prescription drugs under Medicare Part D
  • For additional health care coverage and benefits not included in Original Medicare, which is why many eligible individuals enroll in these types of plans

Rest assured that if you choose a Medicare Advantage plan instead of Original Medicare, you don’t lose your coverage for Medicare Parts A and B.

With our MedStar Medicare Choice plans, you receive these added benefits for a $0 monthly premium. (You must continue to pay your Medicare Part B premium).

Click here to learn more about extra benefits and services covered under MedStar Medicare Choice.

Medicare Advantage (Part C) Eligibility

To qualify for a Medicare Advantage plan, you must

  • Enroll in Medicare Part A and Part B coverage.
  • Live within the Plan’s service area.

Note: Unlike Original Medicare, it is less likely you will qualify for Medicare Advantage if you have been diagnosed with End-Stage Renal Disease.

 

What is Medicare Part D?

Original Medicare (Part A and Part B) does not cover prescription drugs. However, Medicare offers an optional program (Medicare Part D) that provides insurance to help you pay for prescriptions. This involves paying an extra monthly premium.

Medicare Part D, also known as Prescription Drug Plans (PDP), provides this coverage for people enrolled in Original Medicare (Part A and Part B) through private companies. Coverage to help you pay for prescription drug costs is available either through stand-alone prescription drug plans (PDPs) or in combination with a Medicare Advantage plan like MedStar Medicare Choice.

Medicare Part D Eligibility

To qualify for a Medicare Part D, you must:

  • Entitled to Medicare Part A and/or enrolled in Part B.
  • Live within the Plan’s service area.

MedStar Medicare Choice includes Part D Coverage

MedStar Medicare Choice provides Part D coverage with the MedStar Medicare Choice plans. If you enroll in MedStar Medicare Choice you will have insurance coverage for brand-name and generic medications. You will pay part of the cost of your prescriptions through copayments or coinsurance. For benefit details, please see the Prescription Drug Coverage section.

Limits of Medicare Part D Plans

Many Medicare drug plans have an initial limit—often called the “donut hole” or “coverage gap”—on how much they cover. During any particular plan year, some people who have high prescription costs may reach this coverage gap. After you reach this limit, you may have to pay 100% of your drug costs before Medicare coverage kicks in.

MedStar Medicare Choice includes Medicare Part D prescription drug coverage at no additional cost. That means, if a MedStar Medicare Choice plan member hits the coverage gap, he or she will pay only the copay for preferred generic drugs. For other drugs, MedStar Medicare Choice will follow Medicare’s pricing guidelines. For benefit details, please see the Prescription Drug Coverage section.

How to Enroll in a Medicare Part D Plan

You can enroll in a Medicare Part D Plan when you are first eligible, which is a seven-month time period called the Initial Enrollment Period. This time frame runs from the three months before the month of your 65th birthday to three months after the month of your 65th birthday.

If you have a disability, you can enroll in a prescription drug plan three months before and three months after your 25th month of disability payments.

 

Do you have Medicare and Medicaid?

You may be eligible for a special kind of healthcare plan, known as a Dual Eligible Special Needs Plan (SNP). Many people find these types of plans easier because they organize your Medicare and Medicaid benefits in one place. These plans also include coverage for prescription drugs. You get all the same rights and coverage as other Medicare and Medicaid members.

It is important to know that you will not lose any of your Medicare or Medicaid benefits if you sign up for MedStar Medicare Choice Dual Advantage (HMO SNP). You can return to your previous coverage under Original Medicare and Medicaid at any time. These types of plans simply make it easier to keep track of all your benefits by having them all under one plan. Plus, you get more benefits that aren’t available with Original Medicare and Medicaid.

Here’s how it works. Right now, you get healthcare coverage from a few places.

Medicare Part A
Medicare Part B
Medicare Part D
Medicaid

Coverage for hospital stays, home health services, and hospice care

Part of Original Medicare

Coverage for doctors’ services, outpatient care, and medical equipment

Part of Original Medicare

Coverage for prescription drugs

Coverage for other services like vision and dental and some healthcare services not covered by Medicare

With MedStar Medicare Choice Dual Advantage (HMO SNP), everything is under one plan.

MedStar Medicare Choice Dual Advantage

Medicare Part A

Medicare Part B

Medicare Part D

Medicaid

  • One place to sign up.
  • One set of benefits to keep track of.
    • One phone number to call if you have questions.
    • Less hassle and paperwork.
    • Extra benefits and more help coordinating your health care.

MedStar Medicare Choice offers a Dual Eligible Special Needs Plan called MedStar Medicare Choice Dual Advantage. Click here to learn more about the benefits and services.

 

Do you have Chronic Heart Failure and/or Diabetes?

You may be eligible for a special kind of healthcare plan, known as a Chronic Condition Special Needs Plan (C-SNP). MedStar Medicare Choice offers a Chronic Condition Special Needs Plan called MedStar Medicare Choice Care Advantage (HMO SNP). Click here to learn more about the benefits and services. The plan includes coverage for prescription drugs and offers extra benefits and services to provide the care you need.

H9915_17_3111 -  Pending CMS Approval

Last Updated Date: 11/8/2016