Understanding Your Options With Medicare

An Introduction to Medicare's Parts

Medicare has four main parts – A, B, C and D.

  • Parts A and B are often referred to as "Original Medicare." This is a fee-for-service health plan operated by the federal government.
  • Part C is called a Medicare Advantage Plan or Medicare Health Plan. These plans are purchased through private insurance companies.
  • You also have the option of getting prescription drug (Part D) coverage and additional coverage called Medicare Supplement Insurance (Medigap).
  • You must be enrolled in Parts A and B to sign up for Parts C or D.

Medicare's Parts in Detail

Part A

  • Covers hospital stays, skilled nursing facilities, some home-health services and hospice care
  • Medicare pays an approved amount for each type of care.
  • There is no monthly premium, but you must pay a yearly deductible before Medicare will cover hospital costs.
  • You are eligible to enroll in Part A starting three months before the month of your 65th birthday, during the month of your 65th birthday, and in the three months after your 65th birthday month.
  • Medicare Part A covers care at Cedars-Sinai Medical Center.

Part B

  • Covers doctor visits, some home-health services, laboratory tests, X-rays and other outpatient care, including some medical supplies and equipment.
  • This is optional coverage and requires that you pay a monthly premium.
  • You are eligible to enroll in Part B starting three months before the month of your 65th birthday, during the month of your 65th birthday, and in the three months after your 65th birthday month.
  • If you opt out of Part B during this initial enrollment period, then decide to enroll at a later date, you may have to pay a higher premium. Your monthly premium for Part B may go up 10 percent for each year you were eligible for but did not enroll in Part B.
  • Medicare Part B covers care from Cedars-Sinai and most of our physicians.

Part C

  • Part C, also known as Medicare Advantage or a Medicare Health plan, is purchased from a private insurance company and typically organized like an HMO or PPO insurance plan.
  • Part C puts coverage from both Part A and Part B into one plan. Most of these plans also include Medicare Part D drug coverage.
  • Cedars-Sinai participates in the following Medicare Advantage plans:
    • Blue Shield 65 Plus HMO
    • CareMore HMO and HMO Special Needs Plans
    • UnitedHealthcare Medicare Advantage HMO
      • AARP MedicareComplete SecureHorizons Plan 1, 2 and 3 (HMO)
        • Note: Cedars-Sinai Medical Group and Cedars-Sinai Health Associates providers are not included in the provider-specific network for Plan 2.
      • AARP MedicareComplete SecureHorizons Essential (HMO)

If you are enrolled in these plans, you must choose a primary care doctor in either the Cedars-Sinai Medical Group or Cedars-Sinai Health Associates and be referred to specialists within these groups. These plans have options that include Part D coverage.

Part D

  • Covers prescription drugs
  • This is optional coverage and requires that you pay a monthly premium, and possibly a deductible and copays for your medications.
  • Most Medicare Advantage (Part C) plans include Part D coverage.
  • You should review a plan’s formulary and compare prices for the drugs you need when shopping for Part D coverage.
  • If you have health insurance through your employer, you should receive a letter letting you know whether your health plan meets the minimum government requirements. If it doesn’t, you’ll need to sign up for Part D coverage.
  • If you want prescription drug coverage it is mandatory that you sign up for Part D as soon as you are eligible for Medicare Parts A and B. If you don’t sign up, you will be charged a penalty of 1 percent of the national average premium cost for Part D coverage based on the number of months you didn’t have creditable prescription drug coverage.

 



Other Medicare Options to Consider

Medical supplement insurance – also called "Medigap" – is a plan that pays some of Medicare’s out-of-pocket costs such as copays and deductibles and certain non-covered services. You must have Medicare Parts A and B to buy a Medigap policy. People with Medicare Advantage plans, however, do not need and cannot use Medigap policies. 

Your Younger Spouse

If your younger spouse is covered by your employer-provided health insurance and will be losing that coverage as you retire, he or she will have a window of time during which they can enroll in a new plan through the Covered California exchange, an insurance broker or directly from an insurance company.