Medicare Explained

Learn about medicareBefore you are eligible to receive Medicare it is important you understand how it affects you.

Medicare is health insurance for people aged 65 and older, people 64 and younger with disabilities and any person with end-stage renal disease (ESRD). As a federal health program, most tax-paying U.S. citizens qualify for Medicare after working for a set period of time. Medicare covers specific medical and health expenses depending on the program you choose. Medicare plans fall into four programs, or “parts,” that cover certain aspects of services.

  • Medicare Part A covers care received from hospitals, skilled nursing facilities, nursing homes, hospice or home health services. Part A is considered Original Medicare along with Part B Medicare.
  • Medicare Part B covers standard medical services needed to treat or diagnose your medical condition and preventative services. If you choose this coverage you agree to pay a premium. However, you are not required to select Medicare Part B coverage.
  • Medicare Part C is also known as Medicare Advantage and combines Medicare Parts A and B. To select Medicare Advantage you will need to meet certain criteria to qualify.
  • Medicare Part D is prescription drug coverage and offered to everyone with Medicare. You do not have to qualify to receive Medicare Part D coverage.

Qualifying for Medicare Advantage

Medicare Advantage allows you to customize a plan using aspects of Medicare Parts A and B. People with Medicare are often surprised to learn that it does not cover all hospitalization and doctor costs. The Gap, or lapse in coverage, means you are responsible for paying more than expected. Prominence Health Plan Medicare Advantage HMOs can fill these gaps and save you money, and to qualify, you must meet the following requirements:

  • Have existing Medicare Parts A and B coverage and pay premiums for Part B.
  • Permanently reside in the following areas:
    • Carson City, Douglas, Lyon, Storey and Washoe counties in Nevada
    • Brooks, Cooke, Deaf Smith, Fannin, Gray, Grayson, Hidalgo, Moore, Potter, Randall and Starr counties in Texas

Although there are exceptions, Medicare Advantage is not available for those with end-stage renal disease.

Turning 65

People who accept Social Security retirement benefits before their 65th birthday will receive a red, white and blue Medicare card in the mail three months before their birthday. Those who receive retirement benefits generally qualify for Medicare Part A automatically, but will need to enroll in Medicare Part B if desired.

If you do not receive Social Security retirement benefits by the time you’re 65, you will need to apply for Medicare during an enrollment period. You can apply in one of three ways:

  • Visit your local Social Security office
  • Call 1-800-772-1213 between the hours of 7 a.m. and 7 p.m., Monday through Friday
  • Or go to www.ssa.gov >

Prominence Health Plan is a Medicare Advantage HMO plan with a Medicare contract. Enrollment depends on contract renewal.

Learn about Medicare enrollment periods >

 
 
 

Y0109_WEBSITE17_CMS Approved 11/10/2016
Last update 10/1/2016