What Is Medicare?

Medicare is health insurance run by the Federal government and is for people age 65 or older; under 65 with certain disabilities; and any age with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.

Medicare is made up of different “Parts.” Medicare Part A provides hospital coverage. Medicare Part B provides optional medical coverage. Together, Parts A and B are known as Original Medicare and form the basis of Medicare coverage.

Original Medicare consists of:

Medicare Part A helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility, hospice and home health care services

Medicare Part B helps cover:

  • Doctor services and outpatient care
  • Some preventive services

Medicare Part B helps pay for about 80 percent of the medical costs that Medicare covers.

If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.

Medicare Part D provides prescription drug coverage.

Medicare Part D Prescription Drug Plans add drug coverage to Original Medicare and other plans. If you have Original Medicare alone and want Medicare drug coverage, you must join one of these plans. Some Medicare Advantage Plans include Part D coverage.

Medicare Supplement Insurance adds to Original Medicare coverage.

These plans do exactly what their name says: they supplement Original Medicare — or in other words, make the coverage provided by Original Medicare more complete. The extra benefits of Medicare Supplements make these plans less affordable than Medicare Advantage Plans.

Medicare Advantage Plans (Part C) are a great combination of benefits and low costs.

Medicare Parts A and B offer the most basic Medicare coverage available. To get more complete coverage, you have a number of options, including Medicare Advantage Plans, which offer more benefits than Original Medicare, usually for the same cost.

To be eligible for an EmblemHealth Medicare Advantage plan, you must meet the following qualifications.

  • You qualify for Medicare Part A (you are 65 or older, or under 65 with certain disabilities); and
  • You are enrolled in and continue to pay for Medicare Part B; and
  • You reside in EmblemHealth’s service area.
  • View EmblemHealth’s HMO and PPO Service Area maps which include the following counties in New York: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk and Westchester.
    EmblemHealth HMO Medicare Service Area Map
    EmblemHealth PPO Medicare Service Area Map

Pre-existing conditions do not matter, and no physical is required.*

*Note: You will not qualify if you have End-Stage Renal Disease (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.

There are several enrollment periods for those who are eligible.

Initial Coverage Election Period (ICEP)
You can enroll when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65).

October 15 - December 7 (Annual Enrollment Period)
If you are eligible for Medicare, you can enroll in or switch plans during this period. Coverage is effective on January 1 of the upcoming year.

Special Election Periods (SEPs)
You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, such as a move or a loss of other insurance coverage. Rules about when you can make changes and the type of changes you can make are different for each SEP. For more information, please see When can a person enroll?

Helpful Medicare resources

2016 EmblemHealth Medicare Made Simple Guide  — A guide to help you make the right Medicare decisions.

2016 CMS Medicare & You Brochure — Helpful information for beneficiaries and caregivers.

Official U.S. Government website for people with Medicare — General information and helpful tools.

Medicare Rights Center — A national not-for-profit consumer service organization dedicated to ensuring that older adults and people with disabilities get affordable health care.

Administration on Aging — The Administration on Aging website is designed to provide a comprehensive overview of a wide variety of topics, programs and services related to aging.

Social Security Administration — 1-800-772-1213, Monday through Friday, 7 am to 7 pm. TTY/TDD users, call 1-800-325-0778.

EPIC Help Line — 1-800-332-3742, Monday through Friday, 8 am to 5 pm. TTY/TDD users should call 1-800-421-1220, Monday through Friday, 8 am to 5 pm.



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