We know Medicare can be confusing, so we’ve put together some common question and answers to help. Let’s dive right in!

First, what exactly is Medicare?

Medicare is a U.S. federal health insurance program established in 1965 for:

  • People age 65 or older
  • People under age 65 with certain disabilities
  • People of all ages with End-Stage Renal Disease

 

What are the different parts of Medicare – A, B, C & D?

Medicare can look like alphabet soup when you’re first learning the lingo. The different “parts” of Medicare help cover specific services:

Part A – Hospitalization. This part helps cover inpatient care in hospitals, skilled nursing facilities (not custodial or long-term care), hospice, and some home health care.

Part B – Medical. This part helps cover doctors’ services, outpatient hospital care, preventive care, physical and occupational therapists, and some home health care.

Part C – Medicare Advantage plans. This part is health coverage run by private companies like PacificSource under contract with Medicare. These plans include both Medicare Part A and Part B in the convenience of one plan and fill in some of the gaps in Medicare coverage.

Part D – Prescription Drugs. Part D coverage is run by private companies approved and under contract with Medicare. These plans help lower prescription drug costs and help protect against higher costs in the future.

 

What’s the difference between Medicare and Medicaid?

Both Medicare and Medicaid are government programs that provide health coverage. The difference? Medicare is for those age 65 and older or those who have a qualifying disability or medical condition; Medicaid provides coverage if you have a very low income. Some people are eligible for both programs.

 

What is the difference between Medicare Advantage and Medicare Supplement (Medigap)?

Medicare Advantage and Medicare Supplement plans both fill in the gaps by covering some of the costs Original Medicare does not cover. Main differences between these plans:

Medicare Advantage Medicare Supplement (Medigap)
Network Wide network of providers Any provider that accepts Medicare (not all providers)
Coverage Covers many services not covered by Original Medicare Generally includes coverage for Medicare-covered services only
ID Cards One ID card Two cards (three if you purchase Part D)
Premiums Premiums the same for all ages Premiums based on your age
Paperwork Less paperwork – plan pays bills on behalf of Medicare.
Value-added extras No-cost fitness programs, hearing aids, etc.

How do I know which Medicare plan is right for me?

The answer to this will depend your unique situation, including your current health, medications, and finances. Here are key questions to ask when comparing plans:

  • What is the plan’s monthly premium?
  • What are the co-pays (if any) for medical services?
  • What is the annual out-of-pocket maximum?
  • Are my doctors in the network?
  • Are my prescriptions covered and, if so, what will they cost?
  • What is the company’s customer service reputation?

 

When am I eligible to enroll Medicare Advantage?

Medicare has 3 main periods during which you can enroll in or change Medicare Advantage plans:

  • Initial enrollment period, when you first become eligible: 3 months before your 65th birthday month or up to 3 months after.
  • During the annual enrollment period: October 15 – December 7
  • During the open enrollment period: January 1 – March 31

There are also special enrollment opportunities, such as when you’ve recently moved or have left employer coverage.

 

Isn’t basic (original) Medicare enough?

There are limitations to Original Medicare. There is no annual limit to your total out-of-pocket expenses. You will continue paying 20% for most services all year. While 20% may not seem high, it can become a significant expense, especially if you are hospitalized.

And in most cases, the following are not covered:

  • Dental
  • Eyeglasses (except post-cataract)
  • Alternative care
  • Long term and personal Care
  • Hearing aids
  • Care outside the U.S.

 

Are Medicare Advantage and Medigap plans available everywhere?

Yes, you can purchase Medicare Advantage or Medigap in all states. PacificSource offer Medicare Advantage plans in select regions of Oregon, Idaho, Montana, and Washington.

 

How do I get started with Medicare?

If you’re already collecting Social Security, enrollment in Medicare is automatic. If you are not yet collecting Social Security, you will need to sign up (online, in person, or by phone) through the Social Security Administration. Visit www.SSA.gov for more info. You’ll need to have Original Medicare before you can add Medicare Advantage or Medigap coverage.

 

Attend a Free Class or Seminar to Learn More

To help you understand and get the most from Medicare, we offer free classes, seminars, and events. Nonmembers welcome!

Medicare classes: These casual meetings outline how Medicare works, what it does and doesn’t cover, and more. Visit medicare.pacificsource.com/Events for dates and locations.

Plan seminars: These presentations are an opportunity to learn more about which Medicare Advantage or Medicare Advantage Prescription Drug plan is right for you. You’ll have access to a company representative with information and applications. Visit medicare.pacificsource.com/Events for dates and locations.

 

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PacificSource Community Health Plans is an HMO/PPO plan with a Medicare contract. Enrollment in PacificSource Medicare depends on contract renewal. For accommodation of persons with special needs at meetings call(888) 863-3637 or TTY (800) 735-2900.