MEDICARE BASICS

You may be new to Medicare coverage or already have a plan. Our goal is to make sure you have a clear understanding of how Original Medicare works with other Medicare plan options so you can choose the plan that best fits your healthcare needs.

WHAT IS ORIGINAL MEDICARE?

Original Medicare is health coverage managed by the federal government. Original Medicare consists of Part A and Part B. You may choose to have only Part A or Part B, but most people choose to have both. Generally, there’s a cost for each service.

Part A covers

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home healthcare

Part B covers

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health (including inpatient, outpatient and partial hospitalization)
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Also, you pay nothing for most preventive services if you get the services through a healthcare provider who accepts Medicare.

WHAT IS A MEDICARE ADVANTAGE PLAN?

Sometimes referred to as Part C, Medicare Advantage plans are health plans provided by private insurance companies. And they must be approved by Original Medicare. These plans can offer a great variety of additional benefits, and for low or no monthly premiums.

A typical Medicare Advantage plan includes Part A and Part B. Some even include Part D, which is prescription drug coverage. Additional benefits may include:

  • Office visits for primary care doctors and specialists
  • Inpatient and outpatient hospital care
  • Preventive services such as annual physicals
  • Dental, vision and hearing

HOW DO YOU ENROLL IN A MEDICARE PLAN?

Medicare plans have what is called an Annual Enrollment Period (AEP). This is the time of year when you’re allowed to shop for Medicare Advantage plans. There are rules for when you can select a plan and for how often you can change a plan you currently have.

Basically, to join a Clarion Health Medicare Advantage plan, you need to:

  • Be 65 or older, or under 65 with certain disabilities
  • Qualify for and be enrolled in Medicare Part A
  • Be enrolled in and continue to pay for Medicare Part B
  • Have legal residence in Clarion Health’s specified service area

In addition, you cannot have End-Stage Renal Disease, except under certain circumstances.

To see Clarion Health’s 2020 service area, click on the “MAP” tab below