Medicare is often divided into different parts based on the covered services or benefits offered.
• Medicare Part A, or Hospital Insurance, covers hospital stays, hospice care, skilled nursing facilities and some home health care.
• Medicare Part B, or Medical Insurance, covers doctor visits, preventive care and screening, and medical supplies.
Medicare Parts A and B work together and are often called original or traditional Medicare. After initial enrollment, there is no annual enrollment for Part A and B. People can use any clinic or hospital that takes Medicare across the country. Both Parts A and B are both accepted at NMHS facilities and providers.
• Medicare Part C, is also known as the Medicare Advantage Plan, which replace traditional Medicare and typically includes prescription drug coverage and other benefits. The plans are managed by private companies that have partnered with Medicare. The plans use networks of providers and facilities, and there are extra costs for non-emergency use of out-of-network providers. Participants can change plans each year during open enrollment. NMHS participates in two Medicare Advantage plans. (See below)
• Medicare Part D covers prescription drugs. Participants in traditional Medicare will need to select a Part D plan to have coverage for prescription medications. Participants can change plans each year during open enrollment.
For more information, visit medicare.gov.
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies.
A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like: copayments, coinsurance and deductibles. MediGap policies allow enrollees to see any provider that accepts Medicare.
• For more information, visit Medicare Supplement (Medigap) at medicare.gov
Medicare Advantage Plans are another way to get coverage for care in the hospital and doctors' offices. Medicare Advantage, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage, so a separate Part D plan is not needed.
Some companies offer Medicare Advantage Plans as a retiree health benefit. These group Medicare Advantage plans are also called Medicare Employer Group Waiver Plans (EGWP).
In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs. Some plans offer out-of-network coverage, but sometimes at a higher cost.
Medicare Advantage Plans plans replace Original Medicare coverage. Health insurance carriers are required to make disclosures to consumers. Please consult with your insurance agent/broker for specifics.
NMHS participates in two Medicare Advantage plans:
• United Healthcare
NMHS does not participate in Humana Medicare Advantage plans.
Remember, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare. Changes to Medicare Advantage plans generally have to be made during open enrollment from Oct. 15-Dec. 7.
Some individuals qualify for both Medicare and Medicaid based on age, financial resources and disability. NMHS participates in two Medicare Advantage plans specifically for this population.
• AETNA D-SNP
• UHC D-SNP
• Shared Health D-SNP