About Medicare

Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

A Couple Terms…

Part

Medicare Parts refer to the sections of Medicare, provided by Medicare.

Plan

Plans refer to the supplemental insurance options you may purchase from private companies to fill in the Medicare gaps.

The Different Parts of Medicare

Medicare Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Medicare Part B (Medical Insurance) helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services

Medicare Part C (Medicare Advantage):

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost

Medicare Part D (Medicare prescription drug coverage):

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Medicare health and drug plans can make changes each year—things like cost, coverage, and which providers and pharmacies are in their networks. Plans can also change their provider networks throughout the year. If you’re in a Medicare health or prescription drug plan, always review the materials your plan sends you, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). Make sure your plan will still meet your needs for the following year. If you’re satisfied that your current plan will meet your needs for next year and it’s still being offered, you don’t need to do anything.

Things to consider when choosing or changing you Medicare coverage.

CONVENIENCE

Where are the doctors’ offices? What are their hours? Do the doctors use electronic health records or prescribe electronically? 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.

COST

How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you pay out-of-pocket? Your costs may vary and may be different if you don’t follow the coverage rules.

COVERAGE

How well does the plan cover the services you need?

DR. & HOSPITAL CHOICE

Do your doctors and other health care providers accept the type of coverage you have? Are the doctors you want to see accepting new patients? Do you need to get referrals? Do you have to choose your hospital and health care providers from a network? If so, is your doctor in the network? Can you go outside of the network?

PRESCRIPTION DRUGS

Do you need to join a Medicare drug plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions (like prior authorization, step therapy, quantity limits, etc.)?

QUALITY OF CARE

Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. Medicare has information to help you compare how well plans and providers work to give you the best care possible.

TRAVEL

Will you have coverage in another state or outside the U.S.?

YOUR OTHER COVERAGE

Do you have, or are you eligible for, other types of health or prescription drug coverage (like from a former or current employer or union)? If so, read the materials from your insurer or plan, or call them to find out how the coverage works with, or is affected by, Medicare. If you have coverage through a former or current employer or union or other source, talk to your benefits administrator, insurer, or plan before making any changes to your coverage. If you drop your coverage, you may not be able to get it back.