Medicare

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Understanding Medicare
Below are some quick facts related to Medicare.

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What Is Medicare?

Medicare is a health insurance program for

• People who are 65 or older,
• People under age 65 with certain disabilities, and
• People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant, sometimes called ESRD).

We understand that Medicare can be confusing. Therefore, we have posted videos from our Partners at ATRIO Health Plans who developed a series of 10 short educational videos that clearly describe how to make sense of the Medicare choices that need to be made, and how to make them.

1. The First Big Decision
2. Enrollment Periods
3. Understanding Original Medicare
4. Understanding Medicare Advantage
5. How to choose a Medicare Plan
6. Working with an Independent Medicare Agent
7. Medicare Prescription Coverage
8. The Extra Help Program
9. A Medicare Resource Overview
10. Understanding the Medicare Drug Formulary
    

The different parts of Medicare help cover specific services:

Medicare 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. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.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. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medicare Part B (Medical Insurance)

Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Medicare Part C (Medicare Advantage Plans)

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. Part C covers all the benefits you receive with Part A and Part B and may offer additional benefits such as dental care, gym memberships, vision care and prescription drug coverage (Part D).

Medicare Part D (prescription drug coverage)

Medicare Part D is Prescription Drug Coverage. Private companies provide the coverage and beneficiaries choose the drug plan and pay a monthly premium. Companies may offer plans with or without prescription drug coverage, therefore if a beneficiary decides not to enroll in a drug plan when they are first eligible they may pay a penalty if they choose to join later.

​When Can I Enroll?

Initial Enrollment Period (IEP)

You’re newly eligible for Medicare because you turn 65: You can sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.

You’re newly eligible for Medicare because you’re disabled and under 65: You can sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.

You’re already eligible for Medicare because of a disability, and you turn 65: You can:

• Sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.
• Switch from your current Medicare Advantage or Medicare Prescription Drug Plan to another plan.
• Drop a Medicare Advantage or Medicare Prescription Drug Plan completely.

You HAVE Medicare Part A coverage, and you get Medicare Part B for the first time by enrolling during the Part B General Enrollment Period (January 1 - March 31): You can sign up for a Medicare Advantage Plan (with or without prescription drug coverage) or a Medicare Prescription Drug Plan.

Annual Enrollment Period (AEP)

The annual enrollment period is when you can make plan changes and occurs every year from October 15th - December 7th. If you don't currently have prescription coverage (Part D) you can also add it during this time. If you're happy with your current coverage, you don't need to do anything and will be automatically re-enrolled for the next calendar year. Any changes you make will take effect January 1 of the next calendar year.

You can do any of the following during the annual enrollment period:

• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
• Drop your Medicare prescription drug coverage completely.

Special Enrollment Periods (SEP)

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEP) and are in addition to the regular enrollment periods that happen each year. Rules about when you can make changes and the type of changes you can make are different for each SEP.

Special Enrollment Periods include:

• You change where you live
• You lose your current coverage
• You have a chance to get other coverage
• Your plan changes its contract with Medicare
• Other special situation

For a full list of qualifying circumstances go to medicare.gov.

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