Medicare Advantage FAQs

• Medicare is a federal health insurance program.
• In order to qualify, you must be a U.S. citizen or lawfully present in the United States.
• You must also meet one of these criteria:
  • Be age 65 or older
  • Be under 65 with certain disabilities
  • Have permanent kidney failure requiring dialysis
• Medicare has four parts:
  • Part A hospital coverage
  • Part B medical coverage
  • Part C Medicare Advantage plans
  • Part D prescription drug coverage
• Enrollment in Original Medicare
• Contact the Social Security Administration to sign up for Original Medicare.
• Call toll-free 1-800-772-1213
• Monday through Friday from 8 a.m. to 7 p.m.
• TTY users should call 1-800-325-0778.

Part A – Hospital Coverage

Part A covers : Inpatient hospital stays, skilled nursing facility expenses, hospice care, and some home health care.

You pay: If you or your spouse worked for 10 years and paid Medicare taxes, you will not have a monthly premium for Part A.

Part B – Covers your doctor visits and more

Part B covers : Doctor and other health care provider services, outpatient care, lab and x-ray services, ambulance services, medical supplies, and preventive services.

You pay: A monthly premium with a yearly deductible before coverage begins. Your monthly premium is calculated based on your adjusted gross income.

Parts A and B together provide coverage both in and out of the hospital.

Part C—Medicare Advantage

After you enroll in Parts A and B, you have the option to enroll in Part C. Also known as Medicare Advantage, Part C is offered through private insurance companies and combines your Part A, Part B, and sometimes Part D benefits into one easy-to-use plan.

Part C covers : Everything that Original Medicare covers and usually more. Some of the most common Medicare Advantage benefits include:

• Dental, vision, and hearing coverage.
• Fitness memberships.
• Allowance for health care products.

You pay: Once enrolled in a Medicare Advantage plan, you continue to pay your Part B premium to Medicare. You may also have a premium for your Medicare Advantage plan, which you pay to the company you are insured by.

Each drug on our Part D formulary belongs to a tier, which determines how much you will pay. As your spending during the year increases, you move through the stages of Part D coverage.

Part D—Prescription drug coverage

Part D covers : Brand-name, generic, and specialty medications. Each plan has a list of drugs it covers, known as a formulary.

You pay: The monthly premium for your Medicare Advantage Plan, which includes Part D coverage or your standalone Part D plan (if applicable). You also pay out-of-pocket costs such as copays, deductibles, and coinsurance included with the plan you choose.

Part D penalty (late enrollment penalty) : A late enrollment penalty on your Part D premium, applies if you did not have Medicare drug coverage or creditable coverage for more than 2 months since becoming eligible for Medicare. This penalty will be added to your monthly premium.

If you have limited income and resources, you may qualify for Extra Help to assist in paying for your Part D drugs. Many people qualify for this Medicare program and don’t even know it. It helps pay some costs, such as these:

• Plan premiums
• Deductibles
• Coverage gap
• Copays
• Coinsurance

To see if you qualify for Extra Help:

Call 1-800-MEDICARE
(1-800-633-4227)
(TTY: 1-877-486-2048).
24 hours a day, 7 days a week, or visit medicare.gov.

Call Social Security
1-800-772-1213
(TTY: 1-800-325-0778)
Monday through Friday from 8 a.m. to 7 p.m.