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Providing Senior Medicare Information

Medicare Part A: Hospital Insurance

Part A is a hospital insurance plan that helps cover inpatient care in hospitals, skilled nursing facility, hospice as well as home healthcare. Most do not pay a Part A premium because they already paid Medicare taxes while working, which is called a “premium-free Part A.”

If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions:

  • You're 65 or older, you're entitled to (or enrolling in) Part B, and you meet the citizenship or residency requirements.

  • You're under 65, disabled, and your premium-free Part A coverage ended because you returned to work. (If you're under 65 and disabled, you can continue to get premium-free Part A for up to 8.5 years after you return to work.)

In most cases, you must also have a Part B if you choose to buy Part A. Check out Help with Medical and Drug Costs If you have limited income and resources, your state may help you pay for Part A and/or Part B.

How Do I Get Part A?

To learn how and when you can sign up for Part A, read this helpful guide

Coverage

For specifics, please visit Your Medicare Coverage. Plan A generally covers the following:

  • Inpatient Care in Hospitals (Such As Critical Access Hospitals, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals)

  • Inpatient Care in a Skilled Nursing Facility (Not Custodial or Long Term Care)

  • Hospice Care Services

  • Home Health Care Services

  • Inpatient Care in a Religious Nonmedical Health Care Institution

Note: Staying overnight in a hospital doesn't always mean you're an inpatient. It’s best practice to always ask if you are an inpatient or an outpatient. For more information, read “Are You a Hospital Inpatient or Outpatient? If You Have Medicare - Ask!

Medicare Part B: Medical Insurance

You pay a Part B premium monthly if you have Part B. Most people will pay the standard amount. Additionally, Social Security will get in touch with people who have to pay more based on their income.

If you don’t sign up for Part B when you are first eligible, there is a chance you might pay a late enrollment penalty. Some people automatically get Part B, but you can still learn how and when to sign up.

Coverage

Part B helps cover the following types of services. If you want to find out the specifics, please check Your Medicare Coverage. 

  • Medically-Necessary Services – Services or supplies that are needed to diagnose or treat your medical condition and meet accepted standards of medical practice (i.e. doctors’ services, outpatient care, home health services, and more)
  • Preventive Services - Healthcare to prevent illness or detect it at an early stage

Are you unsure of your current Medicare plan? Don’t fret; you can check your Medicare card to find out if you have Part B.

Related Links

Medicare Part C: Medicare Advantage

This is another health plan option you may have as part of your Medicare. Medicare Advantage Plans are also known as “Part C” or “MA Plans” and offered by approved private companies.

If you join a Medicare Advantage Plan, it will provide all of your Part A and B coverage. Aside from this, the plan offers extra coverage such as vision, hearing, dental, and/or health and wellness program.

Most, but not all, include Medicare prescription drug coverage or Part D. Medicare pays a fixed amount for your care each month to companies offering MA plans. These aforementioned companies must follow the rules set.

However, each advantage plan can vary and charge different out-of-pocket costs and come with different rules. In addition, these rules can change each year.

Different Types of Medicare Advantage Plans

Health Maintenance Organization (HMO) Plans

Alternatively, there are other types of MA plans available but are not as common. These include the following:

  • HMO Point of Service (HMOPOS) Plans – This is an HMO plan that may allow you to get some services out-of-network at a higher cost.
  • Medical Savings Account (MSA) Plans – This plan combines a high deductible health plan with a bank account. The process involves Medicare depositing money into the account, which you can use to pay for your healthcare services during the year.

How Much Does a Medicare Advantage Plan Cost?

You typically pay a monthly premium in addition to your Part B premium. Each Part C plan can charge various out-of-pocket costs, and it depends:

  • If the plan charges a monthly premium
  • If the plan pays any of your monthly Part B premium
  • If the plan has a yearly deductible or any additional deductibles
  • On how much you pay for each visit or service (copayments or coinsurance)
  • On the type of health care services you need and how often you get them
  • If you follow the plan's rules
  • If you need extra benefits and if the plan charges for them
  • On the plan's yearly limit on your out-of-pocket costs for all medical services

Coverage

Emergency and urgent care are always covered in all types of Medicare Advantage plans. It also covers all the services an Original Medicare plan covers except for hospice care.

Original Medicare’s scopes include hospice care even if you're in an advantage plan. MA plans are not supplemental coverage. Additionally, Plan C may offer extra coverage and most have Medicare prescription drug coverage, also known as Part D, as well.

How Do I Get a Medicare Advantage Plan?

Each MA plan works differently so it’s best that you take the time to find and compare Medicare Health Plans in your area before joining. Medicare also has information on quality to help you compare plans. Once you understand your selected plan’s rules and costs, you can apply.

Other Important Information You Need to Know

  • You have MA plan rights and protections as with Original Medicare.
  • Before you get a service, double check the plan to find out whether it will cover the service you need alongside the costs.
  • Check the plan thoroughly because you are required to follow all the rules.
  • You can join an MA Plan even if you have a pre-existing condition that is not End-Stage Renal Disease.
  • You can only join a plan at a particular time of the year, and you are enrolled in a plan for a year in most cases.
  • If you go to a service provider that is not in the plan, the services are not covered, or your costs will become higher. It depends on your MA plan type.
  • You will have to join another health plan or return to Original Medicare if your plan decides to stop participating in Medicare.

Medicare Part D: Prescription Drug Coverage

This coverage is insurance run by an approved insurance company or other private company. There are two ways to get Part D:

  • Medicare Prescription Drug Plans – These plans add drug coverage to Original Medicare, selected Medicare Cost Plans, selected Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  • Medicare Advantage Plans - These are other Medicare health plans that offer Medicare prescription drug coverage. Through these plans, you get all of your Part A, B, and D. Also, Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs."

For those who initially decided to not join a Medicare drug plan and do not have other creditable prescription drug coverage, you will likely pay a late enrollment penalty.

How Much Does Medicare Prescription Drug Coverage Cost?

Each plan varies in cost and drug coverage, but you can find the right one using the Medicare Plan Finder. Your monthly premium can also be higher depending on your income, and it may include Part D coverage you get from a Medicare Prescription Drug Plan or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. To learn more, visit the Social Security’s website.

Many people also qualify to get Extra Help paying their Medicare prescription drug costs but are not aware. Most who qualify and join a drug plan will get 95% of their costs covered. So make sure that you save every penny with Extra Help and other programs—such as the Medicare Savings Programs.

How Do I Get Medicare Prescription Drug Coverage?

Choosing a Plan

You must have Part A and B to join a Medicare Prescription Drug Plan or a Medicare Advantage Plan. You must also live in the service area of the Medicare drug plan you want to join.

You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. Additionally, if you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents.

Application Process

Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, or enrolling on through the website of Medicare Plan Finder. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227).

Note: Medicare drug plans aren't allowed to call you to enroll you in a plan. Call 1-800-MEDICARE to report a plan that does this.

How Does My Other Insurance Work With Medicare Drug Coverage?

Employer or Union Health Coverage

This is health coverage based on your, your spouse's, or other family member's current or former employment. If you drop your employer or union coverage, you may not be able to get it back, so it’s important that you call your benefits administrator before you make any changes and sign up for any other coverage.

COBRA

After the employment ends or after you lose coverage as a dependent of the covered employee, this Federal law allows you to temporarily keep employer or union health coverage. There may be reasons why you should take Part B instead of COBRA, but COBRA includes creditable prescription drug coverage. Reach out to State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you.

Medigap (Medicare Supplement Insurance) Policy With Prescription Drug Coverage

These policies are no longer sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. But you may want to join a Medicare drug plan instead since most Medigap drug coverage isn't credible.

If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

Federal Employee Health Benefits Program (FEHBP)

You can keep your FEHBP plan, and your plan will let you know who pays first if you join a Medicare drug plan. For more information, contact the Office of Personnel Management. You can also call your plan if you have questions.

Phone Number: 1 (888) 767-6738

Website: The Office of Personnel Management

*TTY users should call 1 (800) 878-5707

Veterans Benefits

You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. Also, you can join a Medicare drug plan, but you can’t use both types of coverage for the same prescription.

For more information, call the VA at 1 (800) 827-1000, or visit the VA website. TTY users should call 1 (800) 829-4833.

TRICARE (Military Health Benefits)

Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. However, you are not required to join a Medicare drug plan if you have TRICARE.

If you do, your Medicare drug plan pays first, and TRICARE pays second. TRICARE won't pay for your prescription drugs if you join a Medicare Advantage Plan with prescription drug coverage.

For more information, call the TRICARE pharmacy contractor at 1 (877) 363-8779, or visit the TRICARE website. TTY users should call 1 (877) 540-6261.

Indian Health Services

You pay nothing and your coverage won't be interrupted if you get prescription drugs through an Indian health pharmacy. Joining a Medicare drug plan may help your Indian health provider with costs because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator. They can help you choose a plan that meets your needs and explain how Medicare works with your health care system.