The A, B, C's and D's of Medicare
If you are turning 65 soon and new to Medicare learn the details about the types of Medicare coverage options below. If you already have a Medicare plan and want to keep your doctor with Hill Physicians Medical Group select one of plans that works with Hill Physicians during your annual enrollment period. Learn more about Medicare Enrollment Periods...
Medicare Part A
Medicare Part A covers hospital care. You can typically start receiving Part A on the first day of the month of your 65th birthday. If you or your spouse paid Medicare taxes for at least 10 years, you typically won’t have to pay a premium.
What kind of health services are covered?
Medicare Part A helps to cover 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
- hospice care
- home health care services
If you already receive benefits from Social Security or the Railroad Retirement Board (RRB), your Medicare Part A coverage will automatically start as soon as you qualify. If you aren’t getting Social Security benefits (for example, if you’re still working), you may need to sign yourself up for Part A, even if you are eligible to receive Part A at no cost.
Medicare Part B
Medicare Part B is optional medical insurance purchased from the federal government. If you are 65 or over, you are eligible. Most people pay a monthly premium for Medicare Part B, usually deducted from their Social Security benefit checks.
What is covered with Part B?
Medicare Part B, covers a range of outpatient services, including:
- Visits to your physician’s office
- Specialist office visits
- Preventive care like flu shots and mammograms
- Lab costs, such as blood work and X-rays
- Wheelchairs, walkers, and other medical equipment
- Physical therapy
- Mental health care
- Ambulance services
- A “Welcome to Medicare” visit (a routine physical that happens within a year of your sign-up for Part B)
- Annual wellness visits in the following years
How do I get Medicare Part B?
Anyone 65 or over can buy this coverage from the federal government. The most common payment method is to have the monthly premium deducted from your Social Security checks.
Helpful Facts About Medicare Eligibility
- If you already get benefits from Social Security or the Railroad Retirement Board (RRB), you may be automatically enrolled in Part B. (This would typically happen on the first day of the month of your 65th birthday.)
- You may qualify for Medicare Part B if you meet criteria for certain disabilities, including end-stage renal disease (ESRD).
How much does Medicare Part B cost?
- Part B premium amounts are set each year by the Centers for Medicare & Medicaid Services (CMS).
- Your yearly income, whether high or low, will affect how much you have to pay.
- If you choose only Original Medicare (Parts A and B together), you’ll also pay a yearly deductible.
- Please note: If you don’t sign up for Part B during your initial enrollment period, you may have to pay a late enrollment penalty.
Medicare Part C
Medicare Advantage Plans
Also known as Medicare Advantage, Medicare Part C offers everything covered by Parts A and B, plus additional benefits.
What services are covered with Medicare Part C?
Medicare Advantage will cover all benefits under Medicare Part A and Medicare Part B, plus other options that can include:
- Emergency and urgent care
- Vision services
- Hearing services
- Dental services
- Health and wellness programs
- Medicare Part D prescription drug coverage
How can I get Medicare Advantage?
In most cases, you can join a Medicare Advantage plan if:
- You are entitled to Part A.
- You’re covered under Part B.
- You live in the plan’s service area.
- You do not have end-stage renal disease (ESRD).
If you meet all 4 of these requirements, you can buy Medicare Advantage through a private insurer - here are the plans that Hill Physicians is working with for the 2018/2019 enrollment period. Once your coverage is active, you can see doctors in the plan’s network (with a cost share for each visit).
Please note: You can only enroll in Part C plans during certain times of year, or if you meet certain special circumstances.
Types of Medicare Part C plans
Considering a Medicare Advantage plan? There are many options, but we’ll break them down into 3 main types.
Medicare Advantage HMO plans
Things you should know:
- These plans will offer all of the benefits of Original Medicare (Parts A and B).
- They may also cover additional benefits.
- Medicare Advantage HMO plans may include Medicare Part D (prescription drug coverage).
- Like many HMOs, these plans use a network of doctors and other providers that you’ll usually have to use for your care.
- If you do visit out-of-network providers, you’ll probably have to cover the cost.
Medicare Cost plans
Medicare Cost plans are available in certain areas of the country. In a Cost plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Part B premium, and a monthly health plan premium (if applicable). If you seek services out of the plan’s network, you also pay any applicable Part A and Part B coinsurance and deductibles.
Like Medicare Advantage HMO, a Medicare Cost plan offers the benefits of Original Medicare (Parts A and B), plus some additional options. It may also offer Medicare Part D (prescription drug coverage).
In a Cost plan you can do the following:
- join even if you only have Part B
- join anytime the plan is accepting new members
- leave anytime and return to Original Medicare
- either get your Medicare prescription drug coverage from the plan (if offered), or join a Medicare prescription drug plan (PDP) to add prescription drug coverage (note: Part D coverage can only be added or dropped during a valid enrollment period)
Medicare Cost plans are only available in certain parts of the country. Check with your health plan to see if a "Cost" plan is availab.e
Medicare Special Needs Plan (SNP)
If you have additional health care needs or a limited income, the Special Needs Plan is a Medicare Advantage plan that might be right for you. You may qualify for a Special Needs Plan if:
- You live with a chronic or disabling condition.
- You live in a nursing home or other institution.
- You simply require an institutional level of care.
- You qualify for both Medicare and state Medicaid (called Medi-Cal in California).
Additional Medicare options
There are other Medicare coverage options available, like Medicare preferred provider organization (PPO) plans, Medicare private fee-for-service (PFFS) plans, and Medicare medical savings account (MSA) plans. For more details we recommend visiting Medicare.gov.
Learn more about the Medicare Enrollment Periods...
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