Medicare Overview for Seniors

Simple to Use. Easy to Understand.

Medicare Eligible Health plans-Private Health Insurance and Health Plan Providers for Residents of Orange County- CA

What is Medicare?

Medicare is the nation's largest health insurance program covering 40 million eligible people across the nation. The Center for Medicare & Medicaid Services (CMS) is the United States Federal government agency responsible for administering program and other health-related programs.

• There are four basic coverage types of Medicare Plans.

What are the Four Basic Types of Medicare Health Plans?

The four main parts of Medicare are Part A, B, C, D, and Medicare Supplement

1. The Original Medical Plan- Part A and Part B: The Original Medicare is a Federally managed health insurance program that is made up of two parts:

• Part A- Hospital Insurance
• Part B- Medical Insurance.

The two plans cover different services, deductibles and co-insurance, and funded from different federal trust funds.

Part A does not charge a premium for participation and Part B does charge a premium when meeting eligibility requirements.

2. Medicare Advantage Plans -Part C:

Medicare Advantage Plans can cover medical alone or both medical and prescription drugs (MA, MAPD).

3. Medicare Prescription Drug Coverage -Part D:

Plans that cover prescription drugs only (PDP).

4. Medicare Supplement Insurance:

Coverage options that can help supplement your Medicare benefits.

 

What do Medicare Health Plans cover?

The Medicare Program offers a variety of health care coverage choices beyond Original Medicare.

PART A - Hospital Insurance:

• Covers specified inpatient hospital services
• Post-hospital skilled nursing care
• Home health services
• Hospice care for aged
• Disabled individuals who meet the eligibility requirements

Part A does not cover long-term care.

Eligibility

Most people get Part A automatically when they turn 65. If you are disabled, you may be eligible three months before and three months after your 25th month of paid Social Security disability. Part A is available at no cost to people who have worked, or whose spouses have worked, for at least 10 years and have paid Medicare taxes through their employer(s). Contact Us

PART B -Medical Insurance:

• Helps pay for doctors’ services
• Outpatient hospital care
• Durable medical equipment
• Home health care services medically required
• Some medical services not covered by Part A.

Eligibility

If you are interested in receiving Part B, you can sign up anytime during a 7-month period that begins 3 months before your 65th birthday. If you are disabled, you may be eligible 3 months before and 3 months after your 25th month of paid Social Security disability.

Part B requires a monthly payment, or premium, for coverage, usually deducted from your Social Security check. The premium you pay depends on when and what plan you choose to enroll in Part B each year.

Late-Enrollment Penalty for Not Enrolling when First Eligible to Enroll

In most cases, premium rates increase by 10 percent for each full 12-month period that you could have had Part B but did not enroll. Consider to enroll in Part B as soon as you become eligible. Contact Us

PART C- Medicare Advantage Plans (MA):

Medicare Advantage Plans give you more options to offset your costs from hospital stays, physician care and a list medical treatments for an unforeseen sickness or injury.

The government allows private health insurance companies and health plan providers to provide all the coverage of Original Medicare or greater benefits.

Many Medicare Advantage plans will offer lower co-payments and cover benefits and some may offer extras services like wellness, vision, hearing and dental care from the Medicare Advantage plan, services not covered by Original Medicare.

Medicare Advantage Plans ( MA) may also include Part D - prescription drug coverage, referred as Medicare Advantage with Prescription Drug (MAPD) coverage.

Coverage under a Medicare Advantage plan replaces your Original Medicare coverage.

You can enroll in a Medicare Advantage plan for a monthly premium. This plan premium is in addition to your Medicare Part B premium. Some members pay $0 monthly plan premium for a Medicare Advantage plan. With low to no premiums, your out-of-pocket costs (like those paid to see a doctor or to be admitted to the hospital) under Medicare Advantage plans may be lower than your expenses would be with traditional Medicare programs.

Eligibility

To be eligible to enroll in a Medicare Advantage plan you:

• Must have both Medicare Part A and Part B
• Must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party
• Must reside in the service area of the plan
• Must not have end-stage renal disease (ESRD)*

If you are under age 65, permanently disabled and have received Social Security disability payments for at least two years, you are also eligible. Contact Us

PART D- Medicare Prescription Drug (PDP):

Regardless of income, health status, or prescription drugs used, prescription drug coverage can save you thousands of dollars from unexpected drug expenses.

Everyone with Medicare can get prescription drug coverage and are eligible to enroll in Part D when they become eligible for Medicare.

Like Medicare Advantage plans, Part D is only available from private health insurance companies and health plan providers. Each plan can vary in cost and drugs covered.  

You have two choices for drug coverage under Part D:

1. Prescription drug coverage as part of a Medicare Advantage plan (MAPD). This will give you all of your coverage in one plan, for one monthly plan premium that often costs less than you would pay for each separately. Or some members pay $0 monthly plan premium for a MAPD.

2. A stand-alone Medicare prescription drug plan (PDP) in addition to your existing Original Medicare (Part A and B) coverage. These plans only offer prescription drug coverage.

Late-Enrollment Penalty for Not Enrolling when First Eligible to Enroll

If an eligible to enroll during the initial eligibility period, a penalty of 1% of the national average Part D premium assessed for each month the participant delays enrollment.

This is a Medicare requirement and cannot be waived or change by the plan. Unless the person qualifies for an exception, such as having creditable coverage, the penalty added to the monthly premium and paid as long as the person enrolled. Contact Us

Important Note: If you currently are a member of a Medicare Advantage (MA) plan, you must sign up for your Medicare Part D drug plan through your MA plan. If you enroll in a different Medicare Part D plan, Medicare automatically will drop MA coverage from your current MA plan.

Medicare Supplement plan (sometimes known as Medigap coverage):

If you have Original Medicare, you can get coverage in addition to Parts A and B provided by private health insurance companies or health plan providers.

This is called a Medicare Supplement plan and it helps you pay for some benefits not covered by Original Medicare (Parts A and B), including deductibles and coinsurance payments.

This type of coverage enables you to visit the doctors and hospitals of your choice. Medicare Supplement does not include Part D coverage.

You cannot enroll in both a Medicare Advantage and a Medicare Supplement Plan.

When can I enroll?

Important Dates:

• You can join when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65- ICEP.

• If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.

• If you did not join when you were first eligible, you can join between November 15 and December 31 of each year. Your coverage will begin on January 1 of the following year.

• Generally, your next opportunity to make a change will be between November 15 and December 31 of each year.

You may be able to join a Medicare Advantage plan or Medicare Prescription Drug Plan at other times in certain situations. For example if you:

• Move out of your plan’s service area
• Have both Medicare and Medicaid
• Live in, or move into or out of an institution (such as a nursing home)
• Have creditable prescription drug coverage and that coverage ends

You can switch to another Medicare Advantage plan during the Open Enrollment Period (OEP) from January 1 to March 31 of any year, but you cannot join or drop Medicare Prescription Drug coverage during that time.

For instance, if you are in a Medicare Advantage plan with prescription drug coverage, you could return to the Original Medicare Plan, but you would have to also join a Medicare Prescription Drug Plan at the same time.

If you have questions about whether or not you can join or switch Medicare plans, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.