Introduction to Medicare 

Medicare is a program run by the federal government that provides healthcare coverage (Health Insurance Coverage) for people who are 65 years or older, under 65 years old if receiving Social Security Disability (SSDI) for enough time, or if somebody has End Stage Renal Disease (ESRD)  or other specific diseases. The federal organization that runs Medicare is called the Centers for Medicare & Medicaid services (CMS). It is funded  by payroll taxes that you pay every time you get a paycheck. Additionally, there is monthly premiums and copays that you pay once you get enrolled into your Medicare Coverage. 

At the time you start being Medicare Eligible and get enrolled, you will be able to decide where you would like to get your Medicare benefits from. You can get them from Original Medicare ,which is the normal Medicare plan that is run directly by the federal government, you can also choose a Medicare Advantage plan, that is a plan through a private health insurance company who can manage your health insurance coverage. These companies are contracted with Medicare to provide healthcare coverage.  Original Medicare is made up of two parts:

• Part A (Inpatient / Hospitalization coverage)
• Part B (Outpatient / Medical Coverage) 

For people who need to get prescription drug coverage, they will need to choose to enroll into an additional Medicare Prescription Drug Coverage Plan (Part D). This Part D plan is in addition to your Part A and Part B coverage. These stand alone prescription drug coverage plans (PDP) will have an additional monthly premium. 

If you decide to enroll into a Private Medicare Advantage Plan, you will still stay enrolled into Medicare. This means you will still have to pay for your monthly Medicare Part B premiums (and your Part A premium if you have one). Under a Medicare Advantage plan, every service that is available under Original Medicare (Part A and Part B) are still covered. But Medicare Advantage plans may have different cost sharing, restrictions and rules that affect how my may receive your medical care. Medicare Advantage plans may also provide a Part D benefit as part of the Medicare Advantage plan. As a note, if you are currently part of a Union or your current or previous employer when you start your Medicare , it’s possible you can be automatically enrolled in the Medicare Advantage plan that is sponsored by your group. You can choose to take original Medicare or a different Medicare Advantage plan if you would like a different plan than your union or employer offers. You would want to consult with your benefits administrator if you decide to leave your employer or union coverage.

When choosing Medicare coverage, you should choose carefully. It is very important to understand what your Medicare coverage choices are, and how they work, before you pick one.  Which type of plan and which company you choose to manage your healthcare will affect your costs, benefits and deductibles. For example, if you have just Original Medicare, you can go to any doctor or healthcare provider who accepts Original Medicare.  On a Medicare Advantage Plan, there will usually be restrictions on the network of healthcare providers that you can use.  This means that there are limits on your doctors and hospitals. The big benefit to Medicare Advantage plans is that they often will provide extra benefits not covered by Original Medicare, these can be things like Vision, Dental, and Transportation and Drug Coverage. 

Medicare is quite different from Medicaid or Medi-Cal, which is another health insurance program provided by the government, but it is for people with limited resources. Medicaid is run by a federal and state partnership that works to provide low income households with comprehensive medical care.  Although eligibility varies from state to state, Medicaid can be enrolled based on alternate criteria like disability status or pregnancy, or based on income and asset limits. But different from Medicaid, Medicare’s eligibility is not based on income.  Additionally, low income individuals may be able to be enrolled into both Medicare and Medicaid at the same time, they are known as “Dual Eligible” or “Medi/Medi”. 

All Medicare beneficiaries receive a red, white, and blue Original Medicare card. This is the card somebody would use if they only have Original Medicare to receive their medical services. If they have chosen to enroll into a Medicare Advantage plan, they will get an Original Medicare card but will use the second Medicare Advantage plan card when they go to a contracted medical services provider. No matter the method of getting your Medicare benefits you should not give your Medicare number to anybody but your Doctors or healthcare providers 

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.