CenterLight Healthcare Direct

About Medicare

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

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.

When you become eligible for Medicare, you will have Original Medicare, the traditional fee-for-service program offered directly through the federal government. Or, you can choose to get Medicare benefits through a Medicare private health plan such as CenterLight Healthcare Direct, a health plan with a Medicare Advantage contract. These plans, which are called “Medicare Advantage” plans, must offer the same benefits as Original Medicare but usually also offer additional benefits. They can have different rules, costs and coverage restrictions.

Coverage is divided into four categories:

Part A covers most hospital, skilled nursing facility, home health and hospice care. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.

Part B covers most doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental healthcare, and some home health and ambulance services. You pay a monthly premium for this coverage to Medicare.

Part C are Medicare Advantage Plans, which are Medicare-approved health plans offered through private insurance companies and include all Part A and Part B along with extra coverage that may include prescriptions (Part D), dental, hearing, vision and wellness programs.

Part D covers prescription drugs.

You can choose different ways to get the services covered by Medicare. In most cases, when you first get Medicare, you are in Original Medicare. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan like CenterLight Healthcare Direct that provides all your Part A, Part B and Part D coverage. You make a choice when you are first eligible for Medicare, and each year you can review your health and prescription needs and switch to a different plan if needed.

CenterLight Healthcare has dedicated Member Services representatives who are available to answer your questions. You can reach our Member Services Department at 1-877-226-8500 seven days a week from 8:00 AM through 8:00 PM. TTY users should call 711. You can also email us at MemberServices@centerlight.org.

You can apply for Medicare by:

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

Clicking here to enroll

For more information about Medicare benefits and eligibility, call 1-800-MEDICARE or visit www.medicare.gov.

You can also obtain assistance and information about benefits, coverage, cost-sharing, grievances and appeals from the Medicare Ombudsman by visiting http://www.medicare.gov/navigation/help-and-support/ombudsman.aspx?Nav=Top.