Medicare Basics: Questions and Answers
Find the answers to commonly asked questions about Medicare.
- What are the basic parts of Medicare?
- Who is eligible for Medicare?
- What are Medicare Special Needs Plans?
- How do I enroll in Medicare?
- What is a health maintenance organization (HMO)?
What are the basic parts of Medicare?
Medicare is made up of four parts: Part A, Part B, Part C, and Part D.
- Part A is hospital coverage. It helps cover the costs of being in the hospital as an inpatient, as well as long-term hospitalization. Most people automatically get Part A at no monthly cost.
- Part B is medical coverage. It helps cover your doctor visits and outpatient care, as well as some preventive services that help maintain your health. Medicare Part B has a monthly premium. Once you meet a certain amount of spending, known as your deductible, Part B generally covers about 80% of your costs for Medicare-approved services.
- Part C is also known as a Medicare Advantage Plan. Part C is provided by plans like Keystone First VIP Choice (HMO SNP) that have been approved by the Centers for Medicare & Medicaid Services (CMS) and have contracts with Medicare to cover medical and hospitalization care for their members. They can also offer extra benefits that original Medicare doesn't cover, such as hearing, dental and vision services.
- Part D is prescription drug coverage. Like Part C, it is also provided by private companies like Keystone First VIP Choice that have a contract with CMS. It is designed to lower the amount that you pay for your prescription drugs. You can purchase a Part D plan to go with original Medicare, or prescription drug coverage may be included with a Medicare Advantage plan.
Who is eligible for Medicare?
Turning 65? Medicare is the federal government's health insurance program. It is also known as original Medicare. Medicare provides medical and health-related services to:
- People age 65 and older.
- People of any age who are qualified as disabled.
- People of any age who have Lou Gehrig's disease (also called amyotrophic lateral sclerosis [ALS]).
What are Medicare Special Needs Plans?
- Medicare Special Needs Plans (also known as SNPs) are Medicare Advantage plans designed for people who have special needs.
- A Dual-Eligible SNP, like Keystone First VIP Choice, is a Medicare Advantage plan especially for people who get both Medicare and Medicaid benefits.
How do I enroll in Medicare?
- You are automatically enrolled in Medicare when you turn 65 if you're receiving Social Security or Railroad Retirement Board payments.
- If you're receiving Social Security benefits or Railroad Retirement Board benefits, you'll receive information in the mail three months before your 65th birthday explaining your options.
- If you become eligible for Medicare because of a disability and have been receiving Social Security Disability Insurance (SSDI) or railroad disability annuity checks for 24 months, you should automatically be enrolled in both Medicare Parts A and B at the start of your 25th month.
- If you are not yet receiving Social Security payments, then you will have to contact Social Security to enroll.
- You can call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778), visit them online at www.ssa.gov, or apply at your local Social Security office. It's a good idea to do this well before your 65th birthday so you can start receiving benefits as soon as you are eligible.
What is a health maintenance organization (HMO)?
An HMO is a type of health plan that uses a network of health care providers. These providers — doctors, dentists, nurse practitioners, pharmacies, and hospitals — treat members and help prevent them from getting sick.
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