Understanding Medicare

If you're new to Medicare it can be confusing. We're here to answer your questions and help you make an informed decision. If you don't find the answers you're looking for, come to one of our Providence Medicare Advantage Plans informational meetings  held at convenient locations throughout the community. Get your questions answered and speak to a Providence representative all in one place!

What is Medicare?

Medicare is an insurance program offered through the federal government that covers medical services and hospital care for people 65 or older, younger people with certain disabilities and people with End Stage Renal Disease (ESRD). Medicare is made up of Part A, Part B, Part C and Part D. Sometimes referred to as Original Medicare, Part A and Part B are provided by the federal government. Part C and Part D are provided by private health insurance companies but still follow federally mandated Medicare guidelines.

Medicare Part A: Hospital coverage

Also known as hospital insurance, Medicare Part A covers inpatient services including hospital care, skilled nursing facility care, nursing home care, hospice and home health services. Read more ›

Medicare Part B: Outpatient/physician services coverage

Also known as outpatient medical insurance, Part B covers medically necessary and preventive services such as lab tests, surgeries and doctor visits, and supplies such as wheelchairs and walkers (considered medically necessary to treat a disease or condition). Read more ›

Medicare Part C: Medicare Advantage Plans

Also known as Medicare Advantage Plans, Part C is an alternative to Part A and Part B and is provided by private health insurance companies (like Providence) who are approved by Medicare. Part C covers all the benefits you receive with Part A and Part B and may offer additional benefits such as dental care, gym memberships, vision care and prescription coverage (Part D). Read more ›

Medicare Part D: Prescription drug coverage

Also known as Medicare Prescription Drug insurance, Part D is offered by private health insurance companies such as Providence. If you have Part A and Part B, or if you have a Part C Medicare Advantage Plan, you may choose to purchase a separate Part D prescription plan from a private health insurance provider. Read more ›

Medigap: Medicare supplemental insurance

Also known as Medicare supplemental insurance, Medigap is another option for filling in coverage gaps in Original Medicare (Part A and Part B). Read more ›

Information taken from cms.gov.

Who is eligible?

Several factors can contribute to Medicare eligibility. You are eligible to enroll in Medicare if:

  • You are turning 65
  • You are younger than 65 but qualify for Medicare due to a qualifying disability*
  • You have end stage renal disease (ESRD)
  • You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease)

Information taken from cms.gov. Additional information regarding the eligibility of receiving Medicare benefits can be found at medicare.gov.

* Must have received Social Security Disability benefits for 24 months. There is a five month waiting period after a beneficiary is determined to be disabled before a beneficiary begins to collect Social Security Disability benefits.

When can I enroll?

Initial enrollment

Your initial enrollment period (IEP), also called your initial coverage election period (ICEP), will be unique to you depending on your birthday. The initial enrollment period lasts seven months: the three months before your birthday, the month of your birthday, and the three months following your birthday.

Special enrollment periods

Given certain life circumstances, you may be eligible for a special enrollment period (SEP). Circumstances may include the following:

  • If you are moving (even if you stay in your current plan's selling area, you may be able to switch plans if there are new plan options available in your new location)
  • If you have moved out of an institution, such as a long-term care or skilled-nursing facility
  • If you are no longer eligible for Medicaid
  • If your plan has changed its contract

For the full list of qualifying circumstances, go to cms.gov.

Annual enrollment period

Also referred to as annual election period (AEP), the annual enrollment period is when you can make plan changes. If you don't currently have prescription coverage (Part D) you can also add it during this time. If you're happy with your current coverage, you don't need to do anything and will be automatically re-enrolled for the next calendar year. Any changes you make will take effect January 1 of the next calendar year.

Medicare Advantage Open Enrollment Period

The 2020 Open Enrollment period is from January 1 to March 31, 2020. During this time, members may enroll in another Medicare Advantage plan, or disenroll from their Medicare Advantage plan and return to Original Medicare. Individuals may make only one election during the Open Enrollment period.

Information taken from cms.gov.