Medicare is the federal health insurance program for people who are 65 or older, certain younger people who have disabilities, and people with End-Stage Renal Disease.  There are different parts of Medicare for specific services.  The official U.S. Government site for Medicare (medicare.gov) offers a platform where people can access information and services for different purposes.

Getting Started

On this website, you are able to access information about whether you are eligible for Medicare and whether you get Medicare automatically. You also learn your Medicare coverage choices and how Medicare works with other insurance. You can Medicare online through the social security’s website, sign up for a change on your Medicare coverage (which includes your Medicare Advantage Plan i.e. Part C or Medicare Prescription Drug Coverage i.e. Part D), find and compare drug plans, health plans, and Medicare Supplement Insurance (Medigap) policies, and check your Current or future Medicare enrollment.

Medicare Part A (Hospital Insurance)

Through Medicare Part A, your inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care services are covered.

Medicare Part B (Medical Insurance)

Through Medicare Part B, doctors’ services, outpatient care, medical supplies and preventive services are covered.

Medicare Part D (Prescription drug coverage)

Through Part D, original Medicare, Some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans which are offered by insurance companies and other private companies approved by Medicare are covered. You can also get a list of covered prescription drugs, generic drugs, and tiers.

Medicare Part C (Advantage Plan)

Part C is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

Costs

Medicare.gov allows you to learn about the most cost efficient options you have so that you can choose the most suitable plan for yourself. You are able to learn about monthly premiums, Income Related Monthly Adjustment Amounts, out-of-pocket costs, late enrollment penalties, deductibles, co-payments, and co-insurance.

Supplements and other insurance

Medicare works with other insurance and private companies. Through medicare.gov, you are able to learn how benefits are coordinated when you have Medicare and other health insurance.  If you are retired, Medicare pays first and then your retiree coverage pays second. The Medicare Supplement Insurance (Medigap) helps pay some of the health care costs that Original Medicare doesn’t cover. You can find and compare Medigap policies, what they cover and the companies that sell Medigap policies in your area. if you are traveling out of the United States, you can also find out which Medigap policies offer coverage for you.

Claims and appeals

Often times, conflicts arise. Medicare makes it easy for members to resolve conflicts without a lot of trouble. Through Medicare.gov, you can file a complaint/grievance if you have concerns about the quality of care or other services you get from a Medicare provider. You can also contact your State Health Insurance Assistance Program (SHIP) for local, personalized Medicare counseling. You have the chance to get information o how and when to file a claim for your Medicare bill. Medicare.gov allows you to check your claim status and file an appeal for a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan. Through the website, you can learn how to get a fast appeal, know you Medicare options, rights and protections, and sign an authorization form to disclose personal health information.

Medicare.gov also allows you to access your personalized Medicare information for free, learn about specific documents like your living will and durable power of attorney, and plan for long-term care payment. You can access services like electronic prescribing, electronic health record, the Medicare blue button (which offers a safe, secure, reliable, and easy way to download your personal health information), and also coordinate your care.

Attention!

Starting mid-August, you will likely begin to receive notices regarding changes in your Medicare coverage.
Please, do not wait until October 15th when Open Enrollment begins. Reach out as soon as you're able and have all your Medicare and AEP questions answered!