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Medicare FAQ

Basic Medicare Questions

Medicare is a federal health insurance program for people ages 65 or older. Others younger than 65 may also be eligible if they have certain disabilities or diseases, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), otherwise known as Lou Gehrig's disease.

Medicare is also made up of four parts:

  • Medicare Parts A and B - most commonly known as Original Medicare
  • Medicare Part C (Medicare Advantage)
  • Medicare Part D (Prescription Drug Coverage)

Original Medicare is made up of Medicare Part A and Part B.

Medicare Part A covers most inpatient costs and can include the costs of hospital stays, skilled nursing facility care, and some hospice and homecare benefits

Medicare Part B covers doctor visits, and can include the costs of X-rays, lab tests, chemotherapy and vaccinations.

Medicare Advantage, or Medicare Part C, is a Medicare-contracted plan provided by private insurance companies that offer additional benefits Original Medicare does not cover. Some additional benefits that Memorial Hermann Advantage HMO provides are prescription drug coverage, dental, hearing and vision benefits, and a maximum cap on out-of-pocket costs.

Learn more about why a Medicare Advantage plan may be right for you.

You are eligible for Medicare if:

  • You are 65 years or older
  • You are under the age of 65 and have a qualifying disability
  • You are a U.S. citizen or a permanent legal resident; and
  • You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits - usually having earned 40 credits from about 10 years of work - even if you are not yet receiving these benefits
  • You or your spouse is a government employee or retiree who has not paid into Social Security, but has paid Medicare payroll taxes while working

You qualify for Memorial Hermann Medicare Advantage HMO plan if you are already enrolled in Original Medicare (both Medicare Part A and Part B) and live in Harris, Fort Bend or Montgomery counties in Texas.

Learn about exceptions to Medicare eligibility.

The biggest difference between Original Medicare and Medicare Advantage is that Medicare Advantage is run by private insurance companies and provides additional benefits that Original Medicare does not cover. For example, the Memorial Hermann Advantage HMO plan offers prescription drug coverage, dental, hearing aid and annual vision examination coverage, and a maximum on out-of-pocket costs.

Some plans charge an additional premium for their Medicare Advantage plan, meaning that you pay both your Part B premium and your private insurance plan’s premium each month. With the Memorial Hermann Advantage HMO plan, there is no monthly plan premium, so you only have to pay your required Part B premium every month.

Learn more about the difference between Original Medicare and Medicare Advantage.

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Questions About Medicare Costs

The cost of Medicare Advantage plans varies by plan and by the health services and benefits you will need. To know the full cost, you need to consider cost factors such as whether the plan charges a monthly premium, if there is an annual deductible, what the individual services copays are, what the maximum on out-of-pocket costs are, and whether or not you will need care in or outside of the plan's network.

An insurance deductible is the amount of money you must pay before your health insurance company makes payments toward your health care.

Insurance copay is the amount you pay for a health care service, typically at the time of service. The amount of the copay depends on your plan and the health care service.

An insurance premium is the amount you pay monthly, quarterly or yearly for health insurance. There is no monthly premium cost for being enrolled in the Memorial Hermann Advantage HMO plan.

Questions About Medicare Advantage Enrollment

You can enroll in the Memorial Hermann Advantage HMO plan online, by phone, by mail or with the assistance of one of our licensed insurance agents. Refer to our enrollment instructions for more detailed information.

You can enroll in a Medicare Advantage Plan at these times:.

  • When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
  • If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability.
  • Between October 15 - December 7 each year, and your coverage will begin on January 1 of the following year.
  • Between January 1– March 31, if you’re in a Medicare Advantage Plan, you can change Medicare Advantage Plans, or leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until March 31 to also join a Medicare Prescription Drug Plan to add drug coverage. Generally, your coverage will begin the first day of the month after the plan gets your enrollment request.

You can enroll in a Medicare Advantage Plan at these times:.

  • If you move out of your plan's service area
  • If you have both Medicare and Medicaid
  • If you qualify for "extra help"
  • If you live in an institution
  • If you were released from jail
  • Other special circumstances (such as losing employer group coverage)

Yes, you can help someone else enroll in Medicare or Medicare Advantage if you are a verified authorized representative. The individual you are helping must provide this in written consent. Learn more about helping someone enroll in Medicare.

You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over. (Please note that by clicking on these links, you will be leaving the Memorial Hermann Advantage HMO website.)

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