• What is Medicare and what are the different parts?
• I Will Soon Be 65, What Are My Medicare Choices?
• What Does Medicare Part A Cover?
• How and when do I apply for Medicare Part A?
• What Does Medicare Part B Cover?
• How and when do I apply for Medicare Part B?
• What Is the Medicare Part D Coverage Gap?
• What are Medicare Advantage Plans?
• Why should I choose a Medicare Advantage Plan over Original Medicare alone or Original Medicare with a Medicare Supplement Plan?
• Why Are Preventive Services Important?
• Does Medicare Cover Dental Services?
• Does Medicare Cover Me When I Travel Outside the United States?
• I Can't Afford My Medicare and Drug Coverage Premiums. What Can I Do?

What is Medicare and what are the different parts?

The Original Medicare Plan has two parts: Part A (hospital Insurance) and Part B (medical Insurance). It is a fee-for-service health plan. You pay a deductible, and after meeting your deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

• Medicare Part A - Hospital Insurance

Most people do not pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (hospital insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

• Medicare Part B - Medical Insurance

Most people pay a monthly premium for Part B. Medicare Part B (medical insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

• Medicare Part C – Medicare Advantage Plans

Medicare Part C includes all Medicare Advantage plans such as Managed Care Organizations, which are provided by private insurers, like ConnectiCare, who are approved by Medicare.

Medicare Advantage plans provide all of your Part A and Part B benefits and must cover at least all of the medically-necessary services that the Original Medicare Plan provides. In addition, Medicare Advantage plans generally offer extra benefits like preventive care and wellness programs. Many Medicare Advantage plans also include Part D Prescription Drug Coverage (see Part D below).

With a Medicare Advantage plan, you can have all of your coverage from a single health plan, which will make things easier and more convenient for you.

• Medicare Part D – Prescription Drug Coverage

Medicare Part D is the voluntary prescription drug insurance coverage that went into effect January 1, 2006. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

I Will Soon Be 65, What Are My Medicare Choices?

You have two main choices for how you get your Medicare – Original Medicare or a Medicare Advantage Plan. If you choose Original Medicare (which includes Part A Hospital Insurance and Part B Medical Insurance), you will also have the option to enroll in a Part D Prescription Plan. You will also need to decide if you want to purchase Medicare Supplement Insurance (Medigap) to pay for the "gaps" in Medicare coverage.

If you choose a Medicare Advantage Plan, you will have the option to select a plan that includes prescription drug coverage. If you have a Medicare Advantage Plan, you do not need Medigap coverage.

What does Medicare Part A cover?

Medicare Part A, also known as the Hospital Insurance program, helps cover the costs of care in the following facilities:

• Inpatient care in hospitals
• Inpatient care in a skilled nursing facility
• Inpatient rehabilitation facility
• Hospice care services
• Some home health care services
• Inpatient mental health and psychiatric care

If you are eligible for Medicare you will not have to pay a monthly premium for Part A if you or your spouse paid Medicare payroll taxes while working.

How and when do I apply for Medicare Part A?

To apply for Medicare Part A, contact your local Social Security Administration office or, if either you or your spouse worked for the railroad, contact the Railroad Retirement Board (RRB).

Many People Automatically Get Part A:

If you get benefits from Social Security or the Railroad Retirement Board (RRB), you automatically get Part A starting the first day of the month you turn age 65. If you are under age 65 and disabled, you automatically get Part A after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You will get your Medicare card in the mail three months before your 65th birthday or your 25th month of disability.

Most people don't pay a Part A premium because they paid Medicare taxes while working.

Some People Need to Sign up for Part A:

If you aren't getting Social Security or Railroad Retirement Board (RRB) benefits (for instance, because you are still working), you will need to sign up for Part A. You will need to sign up even if you are eligible for premium-free Part A. You should contact Social Security three months before you turn age 65. If you worked for a railroad, contact the Railroad Retirement Board (RRB) to sign up.

If you aren't eligible for premium-free Part A, you can buy it during the following times:

• Initial Enrollment Period - When you first become eligible for Medicare (three months before you turn age 65 to three months after the month you turn age 65).
• General Enrollment Period - Between January 1–March 31 each year.
• Special Enrollment Period - If you or your spouse (or family member if you are disabled) is working and has group health plan coverage through the employer or union.
• Special Enrollment Period for International Volunteers - If you are serving as a volunteer in a foreign country.

For more information on Part A, call Social Security, or visit www.socialsecurity.gov. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772.

What Does Medicare Part B Cover?

Medicare Part B is also known as the Medical Insurance program. In general, Part B covers two types of services:

• Medical services – healthcare that you may need to diagnose and treat a medical condition. Medicare will only pay for services that they define as being medically necessary.
• Preventive services – healthcare to prevent illness (such as a flu shot) or help detect an illness in an early stage so it can be managed before getting worse (such as screening for colon cancer).

Under Part B, Medicare helps pay for durable medical equipment such as oxygen equipment, wheelchairs, walkers, and other medically necessary equipment that your doctor prescribes to use in your home.

How and when do I apply for Medicare Part B?

To apply for Medicare Part B, contact your local Social Security Administration office or, if either you or your spouse worked for the railroad, contact the Railroad Retirement Board (RRB).

You have a seven-month enrollment period that begins three months before you turn 65. Try to apply early so your part B coverage start date won't be delayed. Part B is optional and you must pay a monthly premium to stay enrolled in the program.

If you don't enroll during this initial seven-month period, you'll have to wait until the next general enrollment period (January 1 - March 31 of each year). Your Part B coverage will then begin in the following July. You may be required to pay a penalty if you do not enroll in Part B when you are first eligible.

If you didn't sign up for Part B when you first became eligible, you may be able to sign up during one of these times:

• General Enrollment Period - Between January 1–March 31 each year. Your coverage will begin on July 1. The cost of your Part B will go up 10% for each full 12-month period you could have had Part B but didn't sign up for it, unless you qualify for a Special Enrollment Period (see below). You may have to pay this late enrollment penalty as long as you have Part B.
• Special Enrollment Period - If you wait to sign up for Part B because you or your spouse is working and has group health plan coverage based on that work, or if you are disabled and you or a family member is working and has group health plan coverage based on that work, you can sign up for Part B any time while you have group health plan coverage based on current employment or during the 8-month period that begins the month the employment ends, or the group health plan coverage ends, whichever happens first.
• Special Enrollment Period for International Volunteers - If you waited to enroll in Part B because you had health insurance while volunteering in a foreign country, you can sign up during the 6-month period that begins the month you are no longer volunteering outside the United States, or the sponsoring organization is no longer tax exempt, or you no longer have health coverage outside the U.S., whichever comes first.

Usually, you don't pay a late enrollment penalty if you sign up for Part B during a Special Enrollment Period.

Call Social Security at 1-800-772-1213 for more information about your Medicare eligibility and to enroll in Part B (TTY users should call 1-800-325-0778). If you get Railroad Retirement Board (RRB) benefits, call your local RRB office or 1-877-772-5772. For general information about enrolling, visit www.medicare.gov and select, "Find Out if You're Eligible."

What Is the Medicare Part D Coverage Gap?

Most Medicare drug plans have a coverage gap, also known as the "doughnut hole." This means that after you and your drug plan have spent a certain amount of money for covered medications, you have to pay all out-of-pocket costs for your drugs (up to a limit). Your yearly deductible, your co-insurance or copayments, and what you pay in the coverage gap all count toward this limit.

What are Medicare Advantage Plans?

Medicare Advantage plans are health plan options that are approved by Medicare and run by private companies, like ConnectiCare. They are part of the Medicare Program and are sometimes called "Part C" or "MA plans." Medicare pays an amount for your care every month to these private health plans. Medicare Advantage plans must follow rules set by Medicare.

Medicare Advantage plans provide all of your Part A (hospital insurance) and Part B (medical insurance) benefits and must cover at least all of the medically- necessary services that the Original Medicare Plan provides.

Medicare Advantage plans generally offer extra benefits such as preventive care and wellness programs. Many Medicare Advantage plans include Part D Prescription Drug Coverage.

You'll get this comprehensive coverage from a single health plan, which will make things easier and more convenient for you. Overall, Medicare Advantage plans give you choices, letting you select the coverage that really suits your needs.

Why should I choose a Medicare Advantage Plan over Original Medicare alone or Original Medicare with a Medicare Supplement Plan?

The Advantages of a Medicare Advantage Plan:

• Medicare Advantage plans are available with affordable monthly premiums. Some plans offer $0 monthly premiums in addition to your Medicare Part B premium.
• A Medicare Advantage member will continue to receive regular Medicare- covered services. In addition, a Medicare Advantage plan member will also have access to additional services, such as Health and Wellness Support, that neither Medicare Supplement plans nor the Original Medicare Plan provides.
• Prescription Drug Coverage is often included in a Medicare Advantage plan while a Medicare Supplement plan member must enroll in a separate Part D Prescription Drug plan (PDP) and pay an additional premium.
• Medicare Advantage plans offer the convenience of getting comprehensive coverage from a single source.
• Medicare Advantage plans have annual limits on the amount you may have to pay out-of-pocket for medical expenses. If you were to reach your plan's annual limit, the plan will pay 100% of your covered medical expenses for the remainder of the calendar year. You can feel secure knowing that you are protected against unforeseen catastrophic medical costs.

Why Are Preventive Services Important?

Medicare pays for certain healthcare services to prevent illness (such as a flu shot) or help detect an illness in an early stage so it can be managed before getting worse (such as screening for colon cancer). Your doctor can tell you what tests you need and how often you need them.

Does Medicare Cover Dental Services?

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. Medicare Part A may pay for some dental services that you get when you are in the hospital. Some Medicare Advantage plans may include dental benefits as an added benefit. Check with your Medicare Advantage plan directly to see what dental services are covered, if any.

Does Medicare Cover Me When I Travel Outside the United States?

The Original Medicare Plan generally doesn't cover health care while you are traveling outside the U.S. and its territories. Some Medigap policies Foreign Travel Emergency health care coverage when you travel outside the U.S.

Some Medicare Advantage plans may provide worldwide coverage benefits for health care needs when you travel outside the United States. Before traveling outside the country, check with your Medicare Advantage plan regarding travel benefits.

If you know that you will not have Medicare-related coverage when you travel, you may want to consider purchasing a temporary travel health insurance policy.

I Can't Afford My Medicare and Drug Coverage Premiums. What Can I Do?

You have several options if you need help with medical and drug costs, such as premiums, deductibles, and other out-of-pocket expenses. These options include:

• Medicaid
• Medicare Savings Program
• Extra Help and Low-Income Subsidy
• State Pharmaceutical Assistance Program
• Pharmaceutical Assistance Program