Frequently-Asked Questions About Medicare
Q: What is Medicare?
Medicare is a federal government health insurance program that was created in 1965 by the Social Security Administration. It is health insurance for people 65 or older, under 65 with certain disabilities, and any age with end-stage renal disease (ESRD).
Q: What are the Different Parts of Medicare?
There are four different parts of Medicare:
Medicare Part A (Hospital Insurance)
- Helps cover inpatient care in hospitals
- Helps cover skilled nursing facility, hospice and home healthcare
Medicare Part B (Medical Insurance)
- Helps cover doctors’ services and outpatient care
- Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
Medicare Part C (Medicare Advantage Plans)
- Plans that are offered by private companies approved by the Centers for Medicare & Medicaid Services (CMS)
Medicare Part D (Prescription Drug Insurance)
- A prescription drug plan run by private insurance companies approved by Medicare
- Helps cover the cost of prescription drugs
It is important to note that although Medicare does provide benefits and services, it does not cover everything:
- You may have to pay deductibles and coinsurance costs for services. When Medicare covers a service, you usually have to pay for a portion of the cost. That portion of the cost is called a deductible or coinsurance. Deductibles are the amount you are responsible for before Medicare begins to pay. After your deductible is paid, you may also have to pay a coinsurance, which is usually 20% of the cost of the service.
- If you travel outside the United States or its territories, with the exception of Canada and Mexico, Medicare will not cover you for any services, even in the event of an emergency.
Q: Why is Prominence HMO Medicare Advantage Plan a Good Choice for Me?
Often people believe that Medicare pays for all hospitalization and doctor costs. When first enrolled in Medicare, enrollees are surprised to learn that there are gaps in their coverage and that they are responsible for paying for services that Medicare doesn’t completely cover. That’s how Prominence can help you. Our HMO Plan option helps fill in the gaps that Medicare doesn’t cover.
Q: Am I Eligible to Join?
To be considered eligible for Prominence HMO Plan, you must meet the following requirements:
- Be entitled to Medicare Part A (hospitalization), are enrolled in Medicare Part B (medical) and continue to pay your Part B premiums
- Permanently live within the Plan’s service areas which include:
- Nevada: Carson City, Douglas, Lyon, Storey and Washoe counties
- Texas: Brooks, Cooke, Deaf Smith, Fannin, Gray, Grayson, Hidalgo, Moore, Potter, Randall and Starr counties
Note: If you are already covered by both Medicare and Medicaid, you most likely do not need the additional coverage that Prominence HMO would provide.
Q: Can I Keep My Doctor?
With Prominence HMO Plan you will need to choose a primary care provider (PCP) who will work with you to provide the care you need. If your current doctor is part of the Prominence Health Plan network, you can stay with your doctor. If not, you can select a new PCP from our network of quality providers. You will need to receive all your medical services from HMO network providers who will work together to coordinate your care, except in emergency or urgent care situations or for out-of-area dialysis services. You can change your provider at any time by simply calling Member Services.
Q: What Will I Pay?
With Prominence HMO Plan, there are no medical deductibles to pay. Your financial obligations consist of copayments or coinsurance for medical services and Part D drugs and your Part B premium. Our optional dental benefits have a monthly premium. Please note: your copayments/co-insurance must be paid at the time of service.
Last update 9/26/2018