CenterLight Healthcare Direct

Medicare FAQs

What is Medicare?

Medicare is the federal government program that gives you healthcare coverage if you are 65 or older or under 65 and have a disability, no matter your income. When you or your spouse pay taxes, part of the money goes toward Medicare. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that oversees Medicare.

What is the difference between Medicare & Medicaid?

Medicare is different from Medicaid. Medicaid is a state and federal program offering healthcare coverage to people of most ages in certain groups with certain criteria and generally only to those with low incomes.

What does Medicare cover?

The program is divided into three parts: Part A, Part B, and Part D. Part A is called hospital insurance and covers most hospital stay costs, as well as some follow-up costs. Part B, medical insurance, pays doctor and outpatient medical care costs. Part D covers prescription drug costs. Medicare has a standard program for Part D coverage.

What coverage does Medicare provide for prescription drugs?

Medicare has four stages of coverage:

Deductible—you pay for the first $310 of your drug costs

Initial Coverage Period—Medicare pays up to $2,840 of your drug costs, and you pay a 25% copayment

Coverage Gap-- a period of time in which you pay for all your prescription drug costs yourself.

Catastrophic Coverage-- begins once your total annual drug cost exceeds $4,550.

What is a Medicare Advantage plan?

Medicare Advantage plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered healthcare through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

Medicare Health Maintenance Organization (HMOs)

Preferred Provider Organizations (PPO)

Private Fee-for-Service Plans

Medicare Special Needs Plans

What is the difference between original Medicare coverage and Medicare Advantage?

When you become eligible for Medicare, you will have Original Medicare, the traditional fee-for-service program offered directly through the federal government. In Original Medicare, you are covered to go to any doctor or hospital who has been approved to participate in the Medicare program. Or, you can choose to get Medicare benefits through a Medicare private health plan such as CenterLight Healthcare Direct. These plans, which are called “Medicare Advantage” plans, must offer the same benefits as Original Medicare (Part A & Part B) but usually also offer additional benefits and prescription drugs (under Medicare Part D).

 Am I eligible for Medicare?

Your eligibility for Medicare is based on a number of items. Generally, you meet Medicare eligibility if:

You are age 65 or older

You are under 65 with certain disabilities

You have end-stage renal disease (permanent kidney failure treated with dialysis or a transplant) or ALS (Lou Gehrig disease), regardless of your age

Also, for Medicare eligibility, you or your spouse must have worked 10 or more years in Medicare-covered employment. These Medicare eligibility requirements must be met for you to receive coverage. If you already receive Social Security benefits, you don't need to do anything.

How do I enroll in Medicare?

 If you meet Medicare eligibility requirements, you can apply by:

Signing up for Social Security benefits at your local Social Security office

Click here to enroll or call call 1-800-MEDICARE