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What is Medicare? Medicare is a federal health insurance program for people who are 65 or more years old, who have certain qualifying disabilities, or who have End Stage Renal Disease. Part A Covers inpatient hospital stays, skilled nursing facilities, hospice care and some home health care. Part B Covers certain doctor services, outpatient care, medical supplies and preventive services Part C A medical plan offered by a private company (contracted with Medicare) to offer you Part A and Part B benefits. Part D Adds Prescription Drug coverage PART A Hospital Insurance PART B Medical Insurance PART C Medicare Advantage Plans PART D Prescription Drug Coverage
Who Qualifies for Medicare? You may qualify for Medicare and automatically be enrolled: If you are already getting benefits from Social Security or the Railroad Retirement Board, or If you are under age 65 and are disabled, or If you have ALS (Amyotrophic Lateral Sclerosis) If you are automatically enrolled, you ll receive your red, white and blue Medicare card in the mail approximately 3 months prior to your 65 th birthday. You may need to sign up for Part A and B: If you are not receiving Social Security or Railroad Retirement Board Benefits, or If you qualify for Medicare because you have End-Stage Renal Disease To sign up for Part A and B you can apply online at Social Security, call Social Security at 1-800-772-1213 or visit your nearest Social Security office. If you worked for a railroad, you can call the Railroad Retirement Board at 1-877-772-5772. Important: If you don t want Part B, follow the instructions that come with the card and send the card back. If you keep the card, you keep Part B and will be responsible for paying the Part B premiums.
Medicare Advantage Plans Medicare Advantage Plans are a variety of Medicare health plans that are offered by private companies that contract with Medicare to provide you with your Part A and Part B benefits. These plans include Health Maintenance Organizations (HMO s), Preferred Provider Organizations (PPO s), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you enroll in a Medicare Advantage Plan, your Medicare services will be covered through the Advantage Plan, not under Original Medicare. Additionally, most Medicare Advantage Plans offer prescription drug coverage as well. HMO Plans In a typical HMO plan, you are required to visit a doctor, other provider or hospital that is in the plan s provider network, except for emergency care. Most plans require you to choose a Primary Care Physician and require you to obtain a referral from your Primary Care Physician for specialty care. POS Plans These plans work similarly to HMO plans, except that they provide an option for you to go out of the provider network for care. Access to the out-of-network care usually comes at a higher cost to you. PPO Plans In a PPO plan, there is typically less out-of-pocket to you when you utilize the plan s network of providers for your care. You will incur a greater cost if you go outside of the network for your care. Unlike HMO and POS plans, a PPO plan typically does not require you to select a Primary Care Physician.
Medigap Supplemental Plans When you need help paying for the copays, coinsurance and deductibles left behind after Original Medicare pays, a Medigap(also known as Medicare Supplement) plan can fill your needs. These Medicare supplement plans are only available to you if you have Original Medicare. Medigapplans wrap around Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). It does not cover Medicare Part C (Medicare Advantage Plans), Medicare Part D (prescription drug plans) or any other private health insurance, Medicaid, Veterans' Administration benefits, or TRICARE. Medicare supplement plans are available through private insurance companies. The Medigappolicy must be clearly identified as "Medicare supplement insurance." There are 10 different Medigapcoverage options to choose from. The plans are labeled A, B, C, D, F, G, K, L, M and N to differentiate among the benefits of each plan. You may have seen or heard of plans E, H, I and J at one time, but these plans are no longer available. A B C D F G K L M N Medigap Plans: Benefits are the same for each plan regardless of the carrier you choose. The benefits offered through any of these plans, regardless of the insurance carrier, are the same as regulated by state and Federal laws. What sets the plans apart can be any combination of the following: 1. Which carrier administers the plan 2. Which of the plan options the carrier chooses to offer, and 3. The cost of the plan.
Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug coverage, also referred to as Part D, is available to anyone who is eligible for Original Medicare. Part D is only available through a private insurance company that is contracted with Medicare to provide these plans. Each carrier offers different plans, so your out-of-pocket expenses for prescription drugs (copayments, coinsurance and deductible) will vary, as will your cost for the plan. It is best to compare the coverage offered by various carriers to decide which plan is best for you. How Does Part D Work? Your monthly premium is paid to the provider for Part D coverage You are required to pay the full amount of your prescription drug purchases until any deductible is met. After you satisfy any applicable deductible, you will pay a share of the prescription drug costs. The amount you are required to pay could be a flat amount (copayment) or a percentage of the total amount (coinsurance). These payments are normally made directly to the pharmacist when you purchase your prescription drug. Once you have paid $4,700 (in 2012) out of your own pocket for prescription drugs, you automatically get "catastrophic coverage." This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs. Once your plan has paid a certain amount for prescription drugs, you may be required to pay all costs up to a yearly limit. This is commonly referred to as a "coverage gap" or "donut hole." You should read your benefit plan information carefully to see if this provision applies to you. Some plans do not have this gap.