Medicare

What is Medicare?

 

Medicare is the Federal health insurance program for:

  • People who are 65 or older

  • Certain younger people with disabilities

  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

 

The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance) 

Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:

  • Health Maintenance Organizations

  • Preferred Provider Organizations

  • Private Fee-for-Service Plans

  • Special Needs Plans

  • Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

  • Most Medicare services are covered through the plan

  • Medicare services aren’t paid for by Original Medicare

  • Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

  • Original Medicare

  • Some Medicare Cost Plans

  • Some Medicare Private-Fee-for-Service Plans

  • Medicare Medical Savings Account Plans

These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

 

Medicare Part A & B  Sign-up Period

When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.

For example, if you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65

  • Includes the month you turn 65

  • Ends 3 months after the month you turn 65

Your Medicare Coverage Choices

There are 2 main ways to get your Medicare coverage—Original Medicare(Part A and Part B) or a Medicare Advantage Plan (Part C). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Use these steps to help you decide what coverage you want:

Step 1: Decide if you want Original Medicare or a Medicare Advantage Plan (Iike an HMO or PPO)

  • You can choose Original Medicare.

  • You can choose a Medicare Advantage (MA) Plan.

Step 2: Decide if you want prescription drug coverage (Part D)

  • You chose Original Medicare in Step 1.

  • You chose a Medicare Advantage (MA) Plan in Step 1.

Step 3: Decide if you want supplemental coverage

  • You chose Original Medicare in Step 1.

  • You chose a Medicare Advantage (MA) Plan in Step 1.

Joining a Health or Drug Plan

When you decide how to get your Medicare coverage, you might choose a Medicare Advantage Plan (Part C) and/or Medicare prescription drug coverage (Part D).

There are specific times when you can sign up for these plans, or make changes to coverage you already have. You don’t need to sign up for Medicare each year. However, each year you’ll have a chance to review your coverage and change plans.

When you first get Medicare (Initial Enrollment Periods for Part C & Part D)

 

I'm newly eligible for Medicare because I turned 65:

 

What can I do?

Sign up for a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan.

When?

During the 7-month period that:

  • Starts 3 months before the month you turn 65

  • Includes the month you turn 65

  • Ends 3 months after the month you turn 65

 

During certain times each year (yearly enrollment periods for Part C & Part D)

Each year, you can make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year:

Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.

What can I do?

  • 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.

When?

October 15–December 7

What Medicare Advantage & Supplement Plans do we offer?

Direct Insurance Solutions represents national and regional Medicare Advantage & Medicare Supplement Carriers.

For questions or more information, please call one of our Medicare Specialists at 1-800-619-8959

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