WHAT IS MEDICARE?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
What Does Medicare Part A Cover? (Hospital Insurance)
Medicare Part A Coverage includes inpatient hospital stays, nursing facility care, hospice care, and some home health care.
What Does Medicare Part B Cover? (Medical Insurance)
Medicare Part B Coverage includes certain doctors’ services, outpatient care, medical supplies, and preventive services.
What Does Medicare Part C Cover? (Medicare Advantage Plans)
Medicare Part C Coverage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D Coverage adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Things to Consider When Choosing or Changing Medicare Coverage
1. Coverage: How well does the plan cover the services you need?
2. Your Other Coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making changes.
3. Costs: How much are your premiums, deductibles, and other Medicare costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your Medicare costs.
4. Doctor and Hospital Choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and healthcare providers from a network? Do you need to get referrals?
5. Prescription Drugs: Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What’s the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?
6. Quality of Care: Are you satisfied with your medical care? The quality of care and services offered by plans and other healthcare providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.
7. Convenience: Where are the doctor’s offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or store it in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan offers preferred cost sharing, does your pharmacy offer preferred cost-sharing? You may pay less for some drugs at pharmacies that offer preferred cost-sharing. Can you get your prescriptions by mail?
8. Travel: Will the plan cover you if you travel to another state or outside the U.S.?