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MEDICARE BENEFITS

The Different Parts of Medicare
Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant. The different parts of Medicare help cover specific services if you meet certain conditions.

Medicare Part A (Hospital Insurance):

  • Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals).
  • Helps cover skilled nursing facility (not custodial or long-term care), hospice, and home health care services.

Medicare Part B (Medical Insurance):

  • Helps cover doctor services and outpatient care.
  • Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse.
  • Generally pays 80% of the Medicare-approved amount for covered services

Medicare Part C (Medicare Advantage Plans):

  • A way to get Medicare benefits through private companies approved by and under contract with Medicare.
  • Includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.

Medicare Part D (Prescription Drug Coverage):

  • Run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans.
  • Helps cover the cost of prescription drugs.
  • Each plan can vary in cost and drugs covered.

How Other Insurance Works with Medicare Drug Coverage:

Employer or Union Health Coverage
This is health coverage based on your, your spouse’s, or other family member's current or former employment.

If you have prescription drug coverage based on employment, your employer or union will notify you each year to let you know if your drug coverage is creditable. Keep the information you get. Call your benefits administrator for more information before making any changes to your coverage.

COBRA
This is a Federal law that may allow you to temporarily keep employer or union health coverage after the employment ends or after you lose coverage as a dependent of the covered employee.

There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends. Talk with your State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you.

Medigap (Medicare Supplement Insurance) Policy with Prescription Drug Coverage
Medigap policies are no longer sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. But you may want to join a Medicare drug plan instead, because most Medigap drug coverage isn’t creditable.

If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.


How Other Government Insurance Works with Medicare Drug Coverage

Federal Employee Health Benefits Program (FEHBP)
for current and retired Federal employees and their family members.

If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 1-888-767-6738, or visit the Office of Personnel Management website. TTY users should call 1-800-878-5707. You can also call your plan if you have questions.

Veterans Benefits
for veterans and people who served in the U.S. military.

You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 1-800-827-1000, or visit the VA website. TTY users should call 1-800-829-4833.

TRICARE (Military Health Benefits)
for active-duty service members, retirees, and their families.

Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage Plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 1 877 363 8779, or visit the TRICARE website. TTY users should call 1-877-540-6261.

Indian Health Services
for American Indian/Alaska Natives.

If you get prescription drugs through an Indian health pharmacy, you pay nothing and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health provider with costs, because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator - they can help you choose a plan that meets your needs and explain how Medicare works with your health care system.


Help with Medical and Drug Costs

Medicaid
Medicaid is a joint federal and state program that helps pay medical costs for some people with limited incomes and resources. Medicaid also offers benefits not normally covered by Medicare, like help with personal care and rides to doctor appointments. If you qualify for Medicaid in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

How to Apply for Medicaid
Medicaid is run by the states, so rules about eligibility and how to apply are different for each state. Call your state to see if you qualify for your state's Medicaid program. Use the Helpful Contacts Directory to find the phone number.

Medicare Savings Programs
Medicare Savings Programs can help pay all or part of your Part A and/or Part B premiums if you meet certain income and resource limits. There are four types Medicare Savings Programs:

  1. Qualified Medicare Beneficiary (QMB) Program
    You must be eligible for Part A to qualify, even if you’re not enrolled.

  2. Specified Low-Income Medicare Beneficiary (SLMB) Program
    You must be eligible for Part A to qualify, even if you’re not enrolled. If you have income from working, you may qualify for SLMB benefits even if your income is higher than the limits in the chart below.

  3. Qualified Individual (QI) Program
    You must be eligible for Part A to qualify, and you must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. QI benefits aren't available to people who qualify for Medicaid.

  4. Qualified Disabled and Working Individuals (QDWI) Program
    The QDWI program helps pay the Part A premium. You may qualify if you:
    • Are a working disabled person under age 65
    • Lost your premium-free Medicare Part A when you went back to work
    • Aren't getting medical assistance from your state
    • Meet the income and resource limits required by your state

 


AtlantaCare, Inc. Health Insurance Brokers in Atlanta, GA.
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