Personalized Health Care for Bainbridge Island

Medicare

Click on each of the questions below to reveal the answers.

Question 1: How does Medicare work? What is the difference between Original Medicare and a Medicare Advantage Plan?

Original Medicare consists of two different parts:

Part A is Hospital Insurance covering hospital care, skilled nursing facility care, nursing home care (as long as custodial care isn’t the only care you need), hospice care, and home health services.

Part B is Medical Insurance covering services like lab tests, surgeries, and doctor visits and supplies, like wheelchairs and walkers, considered medically necessary to treat a disease or condition.

To find out if a test, item or service is covered, Medicare.gov offers a search engine that can give you answers. Visit http://www.medicare.gov/coverage/your-medicare-coverage.html to find out.

For a comprehensive list of all coverage items you can visit the Medicare Coverage Database http://www.cms.gov/medicare-coverage-database/

A Medicare Advantage Plan, also known as Part C, includes both Part A (Hospital Insurance) and Part B (Medical Insurance) that is covered by private insurance companies approved by Medicare.

In most plans, you need to use plan doctors, hospitals, and other providers or you pay more for all of the costs.

You will also usually pay a monthly premium (in addition to your Part B premium) and may pay a copayment or coinsurance for covered services. Costs, extra coverage, and rules vary.

Question 2: How can I arrange prescription drug coverage under Medicare?

There are two ways to get drug coverage under Medicare:

  1. Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

If you want prescription drug coverage and you are enrolled in a Medicare Advantage Plan you will typically get prescription drug coverage through your plan.

Question 3: How do I join a drug plan?

Once you choose a Medicare drug plan, here’s how you may be able to join:

  • Enroll on the Medicare Plan Finder or on the plan’s website.
  • Complete a paper enrollment form.
  • Call the plan.
  • Call 1-800-MEDICARE (1-800-633-4227).

When you join a Medicare drug plan, you’ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.

Joining a Medicare drug plan may affect your Medicare Advantage Plan

If your Medicare Advantage Plan (Part C) includes prescription drug coverage and you join a Medicare Prescription Drug Plan (Part D), you’ll be disenrolled from your Medicare Advantage Plan and returned toOriginal Medicare.

Question 4: I have Original Medicare. What if I want supplemental coverage?

You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medicare Supplement Insurance (Medigap) policy from a private company. Costs vary by policy and company. Employers and unions may offer similar coverage.

Question 5: Are there other types of Medicare Health Plans?

Besides Medicare Advantage Plans, and Medicare Savings Account (MSA) plans there are other Medicare Health Plans including Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE). Learn more: http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/other-health-plans/other-medicare-health-plans.html

Question 6: How is Medicare coverage determined?

Medicare coverage is based on 3 main factors

  • Federal and state laws.
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

To check your enrollment in Medicare, use this tool: https://www.medicare.gov/find-a-plan/enrollment/check-enrollment.aspx

Question 7: Where can I obtain Medicare forms such as Authorization to Disclose Personal Health Information, Claim forms, Forms to start, stiop or change automatic deductions of my Medicare premium?

You can download many Medicare forms from this page. http://www.medicare.gov/forms-help-and-resources/forms/medicare-forms.html

For a complete list of Medicare forms, see: http://cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html

Question 8: How can I find and compare doctors, plans, hospitals, suppliers, & other providers?

Here are handy links to do just that…

Find and Compare Hospitals: http://www.medicare.gov/hospitalcompare/search.aspx

Find and Compare Nursing Homes: http://www.medicare.gov/hospitalcompare/search.aspx

Find and Compare At-Home Health Care: http://www.medicare.gov/homehealthcompare/search.aspx

Find and Compare Dialysis Facilities: http://www.medicare.gov/Dialysisfacilitycompare/search.aspx

Find and Compare Physicians: http://www.medicare.gov/find-a-doctor/provider-search.aspx

Find and Compare Health & Drug Plans: https://www.medicare.gov/find-a-plan/questions/home.aspx

Find and Compare Medical Suppliers: http://www.medicare.gov/supplierdirectory/search.html

Question 9: I’ve received Medicare letters in the mail on a wide range of topics. What mail is being sent to me, and why?

For a complete list of the mail you may receive as part of your Medicare coverage and an explanation of what it is for. visit this page online: http://www.medicare.gov/forms-help-and-resources/mail-about-medicare/initial-enrollment-questionnaire.html

Question 10: What is MyMedicare.gov?

MyMedicare.gov is a free online service where you can access your personalized Medicare information. With this service, you can:

  • Check your Medicare information, such as your Medicare claims as soon as they are processed and important Medicare-related information specific to you.
  • Find your eligibility, entitlement and preventive service information.
  • Check your health prescription drug enrollment information your Part B deductible information.
  • Manage your prescription drug list personal health information.
  • Create an “On the Go Report” that allows you to print your health information to share with your healthcare providers.

To create your personal MyMedicare.gov account, start here: https://www.mymedicare.gov/

Question 11: How can I get a “Guided Tour” of MyMedicare.gov and the Medicare Plan Finder?

“Virtual tours” from the comfort of your desk chair, right on your computer screen, are just a click away. They can show you how to sign in and register with MyMedicare.gov, how to manage prescription drugs on the site, how to gain access to information if your password is lost, and more. Your guided tour starts here: https://www.mymedicare.gov/help/virtualtour.aspx

There is also a Multimedia tour available for the Medicare Plan Finder with a step-by-step overview on how to complete a plan search. There are five presentations, or “lessons” in all. You can start this tour at: https://www.medicare.gov/find-a-plan/questions/home.aspx

Have more questions? Medicare.gov has a FAQ of its own featuring the top questions asked about all parts of Medicare and providing real answers. Visit https://questions.medicare.gov/

Portions of this FAQ were excerpted from information published on Medicare.gov