Watch Now: Open Enrollment for Medicare

Mark your calendar: Open Enrollment for Medicare continues through Sunday, Dec.  7. Nearly 50 million Americans are covered by Medicare, a federal health insurance program started in 1965 and administered by the U.S. Centers for Medicare & Medicaid Services.

Medicare is designed for:

People age 65 or older.

Those under age 65 with certain disabilities.

People of all ages with permanent kidney failure.

Here are a few facts you should know about Medicare:

How is Medicare organized?

Medicare has four parts:

1.  Part A:  covers hospital bills (as well as skilled nursing facilities, hospice and home healthcare, in certain situations). 

2.  Part B:  covers doctor bills and other outpatient care. 

Note: Parts A and B are sometimes referred to as “Original Medicare.” Enrollment in Part B is voluntary and requires a monthly premium.

3.  Part C: (also called Medicare Advantage) is an optional program offered by private insurance companies that contract with Medicare to provide coverage for Part A, Part B and sometimes Part D benefits. Medicare pays the plans a fixed amount per enrollee to provide services. Specifics of these plans vary by provider.

 Note:  A Medicare beneficiary may choose to obtain Medicare benefits through a Medicare Advantage plan (Part C) rather than Original Medicare.

4.  Part D: provides prescription drug coverage. Part D is also offered through Medicare-approved private insurance companies. Part D is an optional add-on that also requires payment of premiums. 

Who is eligible?

Medicare is open to U.S. citizens and legal permanent U.S. residents. In general, one must have 40 quarters (10 years) of payroll tax contributions on record to receive Medicare.

However, certain individuals who have not made the required payroll tax contributions may also qualify, for example, based on their spouse’s payroll tax contributions, disability or by purchasing Part A benefits.

Does Baptist Health provide services to Medicare?

Baptist Health participates in Original Medicare and in Medicare Advantage HMOs offered by leading insurance companies, including AvMed, Coventry*, Florida Blue, and Medica.  Baptist Health also accepts all Medigap policies (Original Medicare Supplement Insurance).

*Coventry is not accepted at Baptist Hospital, Baptist Outpatient Services or Baptist Health Medical Group.

Baptist Health includes Doctors Hospital, Homestead Hospital, Mariners Hospital**, South Miami Hospital, West Kendall Baptist Hospital, Baptist Outpatient Services, Medical Arts Surgery Center at Baptist, Baptist Surgery and Endoscopy Centers,   Baptist Sleep Center of Galloway and Baptist Sleep Centers of South Florida. 

** Mariners Hospital Medicare participation is limited to Original Medicare only.  No Medicare Advantage HMOs are licensed in Monroe County.

“If you are accustomed to using Baptist Health physicians, hospitals and other Baptist Health facilities, look carefully at the plan’s network to ensure Baptist Health and your physician are included,” said Eric Shatanof, corporate vice president of managed care, network development and medical management at Baptist Health.

To learn more about Medicare, watch the featured video or download the pamphlet: A Simple Guide to Understanding Medicare.

Additional Resources:

More information about enrollment procedures for the 2015 benefit year is available from the Centers for Medicare and Medicaid Services by contacting Medicare at 1-800-633-4227 or visiting Medicare.gov.  You also can contact your current Medicare Advantage plan, or the Medicare Advantage plan you think you may want to enroll in, for more information.

Tags: insurance, Medicare