1. What is Medicare?

Medicare is health insurance for people age 65 and over, under 65 and eligible for Medicare based on disability, and people of all ages with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

2. What is an Original Medicare Plan?

The Original Medicare Plan is one of your health plan choices as part of the Medicare Program. You will stay in the Original Medicare Plan unless you choose to join a Medicare Advantage Plan or other Medicare health plan through a private insurance company.

The Original Medicare Plan is a fee-for-service plan that is managed by the federal government. You pay a set amount for your health care services (deductible) before Medicare pays its part.  Then, Medicare pays its share, and you pay your share (coinsurance or copayment) for covered services and supplies.  If you have a Medigap policy (Medicare supplement), it would typically cover your coinsurance and copayment. 

For more detailed information about Medicare-covered items and services, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week (TTY/TDD: 1-877-486-2048 for the hearing impaired) to get a free copy of Your Medicare Benefits (CMS Pub. No. 10116)

3. What are the different parts of Medicare?

The different parts of Medicare help cover specific services if you meet certain conditions.  Medicare has the following parts:

 

Part A is insurance covering most inpatient hospital care or hospitalization, skilled nursing facility care, home health care and hospice care. 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.

Part B is insurance for outpatient and doctors’ services. Part B also covers some physical and occupational therapist services and some home health care. Most people pay a monthly premium for Part B which is deducted from your Social Security check.

Part C refers to Medicare Advantage plans which are offered through private health insurance companies. Part C plans may provide additional benefits beyond those covered under Medicare Parts A and B. This means you will have all Medicare Part A and B benefits and possibly Medicare Part D benefits with a range of premium options.

Part D refers to Medicare Prescription Drug plans which are offered through private health insurance companies.  Part D provides coverage for some of your prescription drugs. There is a monthly plan premium for this coverage.

For more information on Medicare coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week (TTY/TDD: 1-877-486-2048 for the hearing impaired). Another useful resource is the Centers for Medicare & Medicaid Services (CMS) publication Medicare and You. This publication is located at www.medicare.gov and www.medicare.gov/publications

4. What things should I consider when choosing Medicare coverage?

• Cost—What will you pay out-of-pocket, including premiums? 

 

• Benefits—Are extra benefits and services, like drug coverage, eye exams, routine dental care or hearing aids covered? (These may be covered by some plans.)

 

• Doctor and hospital choice—Can you see the doctor(s) you want to see? Do you need a referral to see a specialist? Can you go to the hospital you want?

 

• Convenience—Where are the doctors’ offices? What are their office hours? Is there paperwork? Are they accepting new patients? Do you spend part of each year in another state?

 

• Prescription drugs—Are they covered under the plan you are looking at? Are your prescription drugs on the plan’s list of covered drugs (formulary)?

 

• Pharmacy choice—Can you use the pharmacy you want? Are the pharmacies convenient?

 

• Quality of care—How is the quality of the plans in your area? Information about quality is available at www.medicare.gov on the web.