www.MedicareInteractive.

org

What does Medicare cover (Parts A, B, C and D)?

Section I.a. Explaining Medicare
Question 4 of 6 (use "Last" or "Next" buttons to see more)

Different parts of Medicare cover different services. You may hear about four parts of
Medicare: Part A, Part B, Part C and Part D.
Original Medicare which is administered directly by the federal government (and is the
way most people get their Medicare) has two parts:

1. Part A (Hospital Insurance) covers most medically necessary hospital, skilled

nursing facility, home health and hospice care. It is free if you have worked and
paid Social Security taxes for at least 40 calendar quarters (10 years); you will
pay a monthly premium if you have worked and paid taxes for less time.
2. Part B (Medical Insurance) covers most medically necessary doctors services,
preventive care, durable medical equipment, hospital outpatient services,
laboratory tests, x-rays, mental health care, and some home health and
ambulance services. You pay a monthly premium for this coverage.

Medicare Part D (outpatient Prescription Drug Insurance) is the part of Medicare that
provides outpatient prescription drug coverage. Part D is provided only through private
insurance companies that have contracts with the governmentit is never provided
directly by the government (like Original Medicare is).

If you want Part D, you must choose Part D coverage that works with your Medicare
health benefits. If you have Original Medicare, choose a stand-alone Part D plan.

Medicare Part C is not a separate benefit. Part C is the part of Medicare policy that
allows private health insurance companies to provide Medicare benefits. These
Medicare private health plans, such as HMOs and PPOs, are known as Medicare
Advantage plans. If you want, you can choose to get your Medicare coverage through a
Medicare Advantage plan instead of Original Medicare.

Medicare Advantage plans must offer at least the same benefits as Original Medicare
(those covered under Parts A and B) but can do so with different rules, costs and
coverage restrictions.You can also get Part D as part of the benefits package if you
choose. Many different kinds of Medicare Advantage plans are available. You may pay
a monthly premium for this coverage, in addition to your Part B premium.

This information was provided by the Medicare Rights Center, the largest independent source of health care information and
assistance in the United States for people with Medicare. Founded in 1989, Medicare Rights Center is a national, nonprofit
consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities
through counseling and advocacy, educational programs and public policy initiatives. You can learn more about Medicare Rights
at www.medicarerights.org. 2015, Medicare Rights Center
Notice: Your use of this site is subject to terms and conditions.

LanguageLine Solutions Confidential Information

What is a Medicare Advantage plan?
Section III.c. Medicare Advantage Plan Overview
Question 1 of 11 (use "Last" or "Next" buttons to see more)

While the majority of people with Medicare get their health coverage from Original
Medicare, some people choose to get their benefits from a Medicare Advantage plan,
sometimes called a Medicare private health plan.

Medicare Advantage plans contract with Medicare and are paid a fixed amount to
provide Medicare benefits. They are generally managed care plans. The most common
types are Health Maintenance Organizations (HMO), Preferred Provider
Organizations (PPO), and Private Fee-For-Service (PFFS) plans.

You may also see Medicare Advantage plans called Special Needs Plans (SNP),
Provider Sponsored Organizations (PSO) and Medicare Medical Savings Accounts
(MSAs).

You still have Medicare if you join a Medicare Advantage plan. In most cases, you
must still pay your Part B monthly premium (and your Part A premium, if you have
one). Each Medicare Advantage plan must provide all Part A and Part B services but
can do so with different rules, costs and restrictions that can affect how and when you
can get care.

All Medicare Advantage plans must include a limit on your out-of-pocket expenses
for Part A and B services. These limits tend to be high. Plans cant charge you more
than Original Medicare for certain services, like chemotherapy and dialysis, but they
can charge you more than Original Medicare for others, like home health and inpatient
hospital services. Medicare Advantage can also provide additional benefits that
Original Medicare does not cover, such as routine vision or dental care.

Different types of plans have different rules for how and where you can get coverage.
However, even plans of the same type may have slightly different rules so you should
always check with a plan directly to find out how coverage works.

Medicare Advantage plans often charge a premium in addition to the Medicare Part B
premium. They also generally charge a fixed amount called a copayment whenever
you receive a service.

You can join any Medicare Advantage plan if:

You have Medicare Parts A and B; and

LanguageLine Solutions Confidential Information

 You live in the plan's service area; and
You do not have End-Stage Renal Disease (ESRD).
o If you have ESRD that requires dialysis or a kidney transplant, you can
enroll in an Medicare Advantage plan if you join a Special Needs Plan
that specifically accepts people with ESRD or if other special
circumstances apply.

If you want Medicare coverage through a Medicare Advantage and also want drug
coverage (Part D), you must generally choose a plan that has this drug coverage as
part of its benefits package. If you join an MSA, a PFFS without drug coverage, or a
Cost Plan, you can join a stand-alone Part D drug plan.

If you have health coverage from your union or current or former employer when you
become eligible for Medicare, your coverage may automatically convert into a
Medicare Advantage plan. You have the choice to stay with this plan, choose Original
Medicare, or switch to another Medicare Advantage plan.

Be aware that if you switch to Original Medicare or another Medicare Advantage

plan instead, the employer or union could terminate or reduce your health benefits, the
health benefits of your dependents, and any other benefits you get from your
company. Talk to your plan before switching to find out how your health benefits and
other benefits will be affected.

LanguageLine Solutions Confidential Information