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Medicare
What is Medicare?
Medicare is the federal health insurance program for people age 65 or older and certain younger people with disabilities. Medicare is often divided into parts based on the benefits offered.
Medicare ABCDs
A
Medicare Part A, or hospital insurance, covers hospital stays, hospice care, skilled nursing facilities and some home health care.
B
Medicare Part B, or medical insurance, covers doctor visits, preventive care and screening, and medical supplies.
C
Medicare Part C, also known as the Medicare Advantage Plan, replaces traditional Medicare and typically includes prescription drug coverage and other benefits.
D
Medicare Part D covers prescription drugs. Participants in traditional Medicare will need to select a Part D plan to have coverage for prescription medications.
Original or Traditional Medicare
Medicare Parts A and B work together and are often called original or traditional Medicare. After initial enrollment, there is no annual enrollment for Part A and B. People can use any clinic or hospital that takes Medicare across the country. Both Parts A and B are both accepted by NMHS hospitals, clinics and providers.
Medicare Advantage
Medicare Advantage plans are another way to get coverage for care in the hospital and doctors' offices. Sometimes called “Part C” or “MA Plans,” Medicare Advantage plans are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage plans include drug coverage, so a separate Part D plan is not needed.
Some companies offer Medicare Advantage plans as a retiree health benefit. These group Medicare Advantage plans are also called Medicare Employer Group Waiver Plans (EGWP).
Use the Right Insurance Card
Medicare Advantage plans replace Original Medicare coverage. Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Changes to Medicare Advantage plans generally must be made during open enrollment from Oct. 15-Dec. 7.
Know Your Network
Medicare Advantage plans use networks of providers and facilities, and there are extra costs for non-emergency use of out-of-network providers. In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some plans offer out-of-network coverage, but sometimes at a higher cost.
When choosing a Medicare Advantage plan, check to make sure that NMHS and your physicians and other providers are participating providers in your plan. You should also check that medications you take are covered.
Health insurance carriers are required to make disclosures to consumers. Please consult with your insurance agent/broker for specifics.
NMHS participates in these Medicare Advantage plans:
NMHS does not participate in Humana Medicare Advantage plans.
Some individuals qualify for both Medicare and Medicaid based on age, financial resources and disability. In these cases, Medicaid benefits cover Medicare premium costs, deductibles, coinsurance and prescription costs. NMHS participates in three Medicare Advantage plans specifically for this population:
Filling the (Medicare) Gap
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. A Medigap policy can help pay some of the health care costs not covered by Original Medicare, like copayments, coinsurance and deductibles. Medigap policies allow you to see any provider that accepts Medicare.
Enrolling in Medigap Coverage
You get a 6 month “Medigap Open Enrollment” period, which starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can enroll in any Medigap policy and the insurance company can’t deny you coverage due to pre-existing health problems. The Medigap Open Enrollment Period is a one-time enrollment. It doesn’t repeat every year, like the Medicare Open Enrollment Period.
Medigap vs. Medicare Advantage
A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan replaces your Original Medicare coverage. A Medigap policy is a supplement to Original Medicare coverage. When you’re getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can’t have both.
Learn more about Medigap plans at medicare.gov.
Please Note
NMHS' participation with any product or insurance plan is subject to change without notice. Additionally, insurance companies offer a variety of plans and may change the names and benefits at any point. Your level of coverage depends on the specific benefits outlined in your level of coverage and your plan. To ensure that NMHS and its providers are in-network, it is your responsibility to verify that NMHS is a participating provider and your benefit plan allows you access as of the day of a visit and/or admission. Please contact your insurance plan to obtain this information.
Because so many people rely on Medicare, it can be fertile ground for scams. AARP lists Medicare card scams as among the most common targeting U.S. seniors.
Scammers can strike anytime, but they are often most active during open enrollment between Oct. 15 and Dec. 7. They are looking to grab Medicare numbers, Social Security numbers, bank accounts, credit card information and other personal information.
Common scams include:
Help obtaining a new or replacement Medicare card or a Medicare card with a chip
Offers of free medical products or services
Threats of cancelling coverage unless you choose a particular prescription plan
Promises to get ineligible procedures or devices covered
Offers of money for services that were never performed
Fake Medicare representatives seeking payment for services
Bogus refunds from Medicare or private insurers related to a lawsuit settlement or pandemic relief
High pressure sales pitches for discounted plans
How can I protect myself?
- Remember that Medicare will never contact you without permission for your Medicare number and other personal information. Medicare representatives will not try to sell you anything. They will not ask for payment over the phone.
- Protect your private personal information by storing ID cards, medical data and sensitive information in a secure place. Do not give out private personal information to those you did not contact.
- Don’t answer calls from phone numbers you don’t recognize. Review any voicemails to see if it’s a person or business you know before returning the call.
- Understand how your health care providers communicate with you and verify your identity to protect your information.
- Look closely at all Medicare-related materials received through the postal service or e-mail. Just because it says Medicare does not mean it came from the Centers for Medicare and Medicaid.
- If you are shopping for Medicare Advantage, Medigap or Part D prescription drug plans, make sure you are dealing with an authorized agent and you understand the plans. Seek help from an attorney, trusted friend or family member to evaluate what is best for you.
- Private companies offering Medicare-related policies must follow strict rules. There are deadlines for enrollment periods, but you should have time to consider any policy.
- When in doubt, do your research. Talk to independent sources and let their expertise give you peace of mind.
Your NMHS patient access specialist (PAS) can help answer questions about insurance and communicate with your insurance company. In most cases, you will be able to connect with a PAS at the hospital, clinic or facility where you are receiving care.