Basics of Medicare

What is Medicare?

Medicare is a federal health insurance program, administered by the Centers for Medicare & Medicaid Services (CMS), that provides health insurance and coverage for millions of Americans. In general, you are eligible for Medicare if you are:

• 65 or older
• under 65, receive Social Security benefits or meet criteria for certain disabilities

Medicare has four main components or parts: Parts A, B, C and D.

• Medicare Part A – Hospital Insurance
  Medicare Part A helps pay for inpatient hospital care, skilled nursing care, some home-health services and hospice care.
• Medicare Part B – Medical Insurance
  Medicare Part B helps pay for physician services, outpatient hospital care, and other medical services not covered by Part A. Part B is optional and is purchased from the federal government for a monthly premium.
  Quick Tip: Together, Parts A and B are known as “Original Medicare.”
• Medicare Part C – Medicare Advantage
  Medicare Part C plans, usually referred to as Medicare Advantage plans, are offered by private health care companies, such as Physicians Health Choice. Part C plans cover all services covered under Parts A and B and provide additional benefits and services. Medicare Advantage plans often include prescription drug coverage (Medicare Part D).
• Medicare Part D – Prescription Drug Coverage
  Medicare Part D helps pay for prescription drugs and is available through private health care companies. Anyone receiving Medicare is eligible and can buy this optional coverage. Part D coverage can be purchased as a separate plan or as part of a Medicare Advantage (Part C) plan. Many Physicians Health Choice plans include Part D coverage.

What are my Medicare coverage options?

Medicare offers many choices: Original Medicare, Medicare Advantage plans and more. Explore some of the Medicare options below to learn more, so you can choose the plan that best meets your health care needs.

Original Medicare

Available through the federal government, this coverage consists of Medicare Part A (hospital insurance) and Part B (medical insurance) only.

Original Medicare covers many health care services but not prescription drugs, routine vision or hearing exams. You can go to any doctor or hospital that accepts Medicare.

Medicare Advantage plans

Sold by private companies, these plans may fill in coverage gaps (such as out-of-pocket costs or additional benefits) in Medicare Part A and B coverage. You can choose a Medicare Advantage plan with or without Part D prescription drug coverage.

Physicians Health Choice offers the following types of Medicare HMO plans:

Medicare HMO Plans

• Offer more benefits than Original Medicare
• Most plans have no additional monthly health plan premium
• Generally include Part D prescription drug coverage
• Feature a network of providers that you must use
• If you visit out-of-network providers, you are usually responsible for the costs (except for emergency care or urgent care when traveling)

Medicare Special Needs Plans (SNP)

• Provide coverage for members with additional health care needs, such as someone with a chronic condition (like Diabetes or Congestive Heart Failure) or someone eligible for both Medicare and Medicaid
• Provides a higher level of coverage for most medical services related to your condition
• Many plans offer no or low monthly premiums and low co-payments for prescription drugs

Compare Physicians Health Care plans >