Kaiser Permanente Guide to Medicare Basics.
The National Medicare program, which was created in 1965,
has given people peace of mind and the security
of knowing they'll have access to health coverage.
Medicare is administered by the Centers for Medicare
and Medicaid Services or CMS and provides health care coverage
to people who are 65 and over and people under 65
who have certain disabilities,
including end-stage renal disease, after diagnosis.
Medicare is made up of Parts: A, B, C,
and D. We'll explore each one,
so you have the information you need.
Let's look at Part A first.
Part A is hospital insurance and provides coverage
for Inpatient hospital, Skilled nursing,
Hospice, Home health care.
Services not covered under Part A include Custodial care
and long term care.
If you've worked at least 10 years
of Social Security covered employment and are over 65,
you generally will pay no monthly premium
for Part A. Once you're eligible, you can sign
up at your Social Security Office.
Then you'll receive a red, white and blue Medicare card.
Next.
Part B is medical insurance.
It covers services like Doctor visits, Preventive services,
Inpatient and outpatient physician services,
Outpatient surgery, Lab, Radiology,
Durable medical equipment, Dialysis,
and other medical services and supplies not covered
under Part A. If you qualify for Part A, you're eligible
for Part B. And you'll keep your Part B benefits for as long
as you continue to pay for them.
And here's something important to remember.
You must sign up for Part B once you are eligible,
because if you don't, you may have
to pay a Late Enrollment Penalty.
This penalty increases the Part B monthly premium by 10 percent
for each 12 month period you decline coverage.
And that amount is not a one-time penalty.
It lasts for as long as you remain enrolled
in Part B. There are exceptions to this penalty,
such as a person or their spouse
who continues to work after age 65.
We've now covered Part A and Part B,
which together make up Original Medicare.
Keep in mind that your employer group
or trust fund-sponsored plans likely offer additional coverage
to Original Medicare.
Let's move on to Part C. Often referred
to as Medicare Advantage, Part C is the part of Medicare
that allows you to choose a private insurance company
to provide your Medicare benefits.
Medicare Advantage Plans must cover all of the services
that Original Medicare covers.
However, hospice care and certain care
for clinical research studies are exceptions.
They're covered under Original Medicare
and not Medicare Advantage Plans.
If you have a Medicare Advantage Plan and need these services,
you can still have them covered under Original Medicare.
Medicare Advantage plans feature a network of providers
that you must use for care.
If you choose to see an out-of-network provider,
you'll be financially responsible, except in the case
of an emergency or urgent care.
When you sign up with a Medicare Advantage plan,
you still have Medicare.
You'll just receive your health care coverage
through a private insurance company.
Once you're enrolled, you will only need
to show the Medicare Advantage plan's member I.D. card
to get care.
But you should still keep your red,
white and blue Medicare card.
And then there is Part D. Part D provides outpatient prescription
drug coverage.
A Part D plan must have a list
of covered drugs called a formulary.
And you may only have one Part D plan at a time.
You're eligible for Part D if you are entitled to benefits
under Part A and/or enrolled
in Part B. The only way you can enroll in Part D is through one
of these options: A Medicare Advantage plan
that includes Part D prescription drug coverage,
a Stand-alone Prescription Drug Plan
which offers prescription drug coverage only,
and some employers and unions.
Like Part B, Part D also has a Late Enrollment Penalty.
The penalty for Part D is one percent of the monthly premium
for every month that you defer your enrollment.
This penalty does not apply to those who are eligible
for Low-Income Subsidy, also called "Extra Help".
To apply for this program and get assistance in paying
for your prescription drug premiums and costs,
contact Social Security or your state Medicaid office
or call 1-800-Medicare for more information.
Now that we've gone over the four parts of Medicare
and the benefits they offer, let's go over how
and when you can enroll in Original Medicare.
The Initial Enrollment Period
for Original Medicare begins 3 months before your 65th birthday
and ends 3 months after the month you turn 65,
a total of 7 months.
If you miss your Initial Enrollment Period, you can sign
up during the General Enrollment Period between January 1
and March 31 each year and your coverage will begin
on July 1 of that same year.
If you decide to continue working after 65,
but lose your employer or union coverage, you can take advantage
of a Special Enrollment Period which is anytime outside
of the General Enrollment or Initial Enrollment Periods.
In the next part, we'll discuss enrollment in Parts C and D.
To be eligible you must: Reside in the approved service area,
and Have Parts A and B Some exceptions apply, such as,
if you have end-stage renal disease also known as ESRD.
Medicare has specific rules around enrolling individuals
with ESRD, unless you qualify for an exception,
you may not be eligible for a Part C plan.
For more information please call 1- 800-Medicare.
Additionally, if you have an employer or union health plan
or other health coverage through a company
that offers Medicare Advantage Plans, you may be able
to join one of their Medicare Advantage Plans.
Most Medicare Advantage plans have limited enrollment periods.
The Initial Enrollment Period for a Medicare Advantage Plan
with Part D is the same as Original Medicare.
If you are retiring at age 65, you have a total of 7 months
to enroll, the 3 months before you turn 65,
your birthday month, and the 3 months after you turn 65.
You may qualify for a continuous enrollment period
if you are eligible for Low Income Subsidy (also referred
to as Extra Help).
To see if you qualify for Extra Help, call 1 (800) Medicare.
There are also Special Election Periods based
on individual beneficiary qualifications that allow you
to change plans or enroll
in a new Medicare Advantage Plan outside
of the regular enrollment periods.
Examples of these Special Election Periods are loss
of employer or union group coverage, qualification
for Low Income Status, relocation,
you have moved or are moving.
Now, you have a smart, easy way
to compare Medicare health plans, apples to apples.
It's called the Medicare Star Quality Ratings.
Each year, CMS uses this system to evaluate all Medicare health
and prescription drug plans.
Plans are given an overall rating from 1 to 5 stars,
5 stars meaning excellent.
These ratings are based on major categories which include:
Preventive Care Chronic Care Prescription Drug Services
Customer Service and Member Satisfaction Whether you're
choosing or changing coverage, these ratings are a simple,
fair way to compare plans in your area
and help you make a more informed choice.
So now you have the confidence of knowing the basics
of Medicare, understanding what the four parts A, B,
C and D represent, the important enrollment periods
and the significance
of the Medicare Star Quality Ratings System.
If you need more information about Social Security
and Medicare, including Medicare Star Quality Ratings,
please use these important websites
and phone numbers displayed here.
These references can also be found
in our enrollment materials.
Thank you for watching and stay well.