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Welcome to Summit Health

Understanding Medicare

When considering a Medicare plan, it’s important to understand how it works and what your options are to get the right plan for you.

What is Medicare?

Medicare is a health insurance program provided by the federal government. Medicare is for people who are age 65 or older, with some exceptions. Explore your options to find out what is right for you.

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Part A — Hospital insurance

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Part B — Medical insurance

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Part C — Medicare Advantage

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Part D — Medicare Prescription Drug Coverage

Original Medicare includes Part A and Part B. It is administered by the federal government. With Original Medicare, you can see healthcare providers throughout the U.S. who accept Medicare patients.


Part A and B do not include:

  • Most outpatient prescription drugs
  • Hearing aids and exams for fitting them
  • Routine vision exams and eyeglasses
  • Routine annual physical exams with lab tests
  • Dental care and dentures
  • Long-term care
  • Travel outside the U.S. with limited exceptions
  • Alternative care, including acupuncture and naturopathic services
  • Medical transport services (not by ambulance)


With a private insurer, like Summit Health, you can have more. Private insurers offer Part C and Part D.

Part C, Medicare Advantage, is the private option for Part A and Part B. It covers extra benefits that Original Medicare does not. Some of these services may include vision, hearing, dental and other health and wellness programs.

Medicare Advantage plans limit your out-of-pocket costs for medical services.

They have an annual maximum. Once you reach that, you will not pay anything for covered medical services for the rest of the year. Some Medicare Advantage plans have specific coverage areas.

For Medicare Part D (prescription drug coverage), there are two options for you:

  • You can enroll in a Medicare Advantage plan that offers prescription drug coverage
  • You can join a stand-alone prescription drug plan from a private insurer

You must have part A and part B before enrolling in a Part C or D option.



What are the differences between Medicare, Social Security and Medicaid?

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Medicare

Health insurance for people age 65 or older and also for individuals under 65 who qualify for disability

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Social Security

 A pension program for individuals (62+ and/or disabled). Social Security (SSA) can also enroll people into Medicare

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Medicaid

A state program that provides healthcare for people with limited income and resources


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What Medicare option is right for you?

When you consider your Medicare plan options, you may want to think about the following:

  • Your lifestyle, priorities and health needs, including chronic conditions
  • Your current coverage. Is it from an employer or retiree plan?
  • Prescription drug coverage
  • Whether or not you need coverage for services that Original Medicare does not cover
  • How often you travel
  • Whether or not you live in another state for part of the year
  • Out-of-pocket costs


Last updated Nov. 6, 2020
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Have questions? We’re here to help. Call us today at 844-827-2355 (TTY users, please call 711). Our customer service team is available from 7 a.m. to 8 p.m., Pacific Time, seven days a week from Oct. 1 to March 31. After March 31, your call will be handled by our automated phone system on weekends and holidays.

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