Medicare Questions

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What are my Medicare health plan choices?

(Please visit our Medicare Basics page for a more comprehensive overview of Medicare.)

Most people get their health care coverage through Original Medicare. Original Medicare, which provides Medicare Part A (Hospital) and Part B (Doctor/Medical) coverage, is a fee-for-service plan managed by the Federal government. This means you are usually charged a fee for each health care service or supply you get. For many services, you will pay an amount called a deductible before Medicare pays its part. Then, when you get a Medicare-covered medical supply or service, Medicare pays its share of the cost of the supply or service, and you pay your share, called the co-insurance or a co-payment. Oftentimes, many people elect to get a Medicare Supplement or Medigap policy to cover the "gaps" (deductibles, co-insurance and other fees) that are not paid by Original Medicare.

Additionally, you may elect to enroll in Part C (which is more commonly referred to as Medicare Health Plans or Medicare Advantage Plans).   These healths plans are Medicare approved and run by private insurance companies. They provide all your Part A and Part B-covered services. Medicare Advantage Plans may offer extra coverage and can include Medicare prescription drug coverage (usually for an extra cost).  These plans are generally an HMO, PPO, or PFFS (private-fee-for-service) type of plan and you may need a referral to see a specialist.  In some plans, you can only see doctors who belong to the plan or go to certain hospitals to get covered services.

You can also join a Part D (Medicare Prescription Drug Plans) to help you lower your prescription drug costs and help you protect against higher costs in the future.

Can I have other types of health insurance?

Yes.  You may already have health care coverage such as employer or retiree coverage or another type of health insurance.  There are times when your other coverage or health insurance must pay before Medicare pays.  Talk to your benefits administrator to see how your other coverage or health insurance works with Medicare.  If you have Original Medicare, you might also want to buy a Medigap (sometimes called “Medicare Supplement Insurance”) policy.  A Medigap policy sold by private insurance companies can help pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (deductibles, co-payments, co-insurance and other costs).

How can I get help to pay health care and prescription costs?

There are programs that help millions of people with Medicare save money each year.  If you have limited income and resources, your state may help pay Medicare premiums and, in some cases, may also pay Medicare deductibles and coinsurance.  Help is also available paying prescription drug costs.  Call 1-800-MEDICARE (1-800-633-4227) for more information.

Where can I get more information on Medicare?

Medicare help is available every day, 24 hours a day, 7 days a week, 365 days a year! Visit www.medicare.gov. or call 1-800-MEDICARE (1-800-633-4227).  You can also get free personalized health insurance counseling from Texas Department on Aging and Disability Services (DADS).  Visit www.dads.state.tx.us or call 1-800-252-9240.

Are pre-existing conditions covered under Medicare?

Yes.  Medicare provides full protection from the  very first day of coverage.  Most Medigap plans dispense with pre-existing  waiting periods if a person enrolls when they are first eligible for Medicare.

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