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About Medicare

We’ve prepared a simple guide for you to learn more about Medicare and the healthcare coverage options. This section will help you choose the coverage that’s best for you.

 

Watch the video and learn a bit more about Medicare.

 

What is Medicare?

Medicare is a federal program that provides healthcare coverage to adults 65 years and older, and/or people younger than that who have certain disabilities, such as kidney failure.
 
This coverage is divided into four parts: Part A and Part B, known as Original Medicare; Part C, known as Medicare Advantage, and Part D, which is a prescription drug coverage.

 

 

Original Medicare consists of Part A and Part B, but is not designed
to cover all costs related to healthcare. This program only covers
80% of medical and hospital expenses. 


Plus, as it provides basic coverage, the program does not include prescription drugs, but there are options to help you cover additional costs.

 

 

 

Medicare Advantage (Part C) is one of the options that help you cover those costs. It includes everything that Original Medicare covers and offers you added-value benefits such as innovative programs and initiatives that promote integral wellbeing.


Medicare Advantage is made up of Platino coverage (for beneficiaries that are eligible for Medicare and the government health plan), and non-Platino.

 

 


Part A – Hospital Coverage

Part A covers hospital services, specialized care centers,
and certain types of home care. Beneficiaries are automatically enrolled in this part once they surpass the
age of 65.

 

 


 

Part B – Medical Coverage

Part B is an optional coverage that includes ambulatory medical services and other services that are not included in Part A. It includes visits to your primary physician and some preventive services such as regular checkups and vaccinations. In Puerto Rico, the beneficiary must apply for Part B from 3 months before to 3 months after turning 65 years at the Social Security office, to avoid late enrollment penalties.

 

 


 

Part C – Medicare Advantage
 

Part C, also known as Medicare Advantage, is a private
plan approved by Medicare that offers a more complete coverage. This plan is available to beneficiaries enrolled
in Part A and Part B, and may be combined with Part D.

 

This part may offer:

Access to doctors and physicians.

Original Medicare deductibles and copayments.

Additional hearing, visual and dental services.

Coverage for emergencies anywhere in the world and routine services in the U.S.

 


 

Part D – Prescription Drug Coverage

Part D covers prescription drugs and offers Medicare beneficiaries an effective and accessible alternative to purchasing medicine and obtaining treatment.

This coverage is optional and is available only through private plans. If the beneficiary does not enroll in Part D when he/she first becomes eligible, and decides to enroll at a later date, he/she may have to pay a penalty. 

 

 

Eligibility


 

How do I know if I am eligible for Medicare?
 

To know if you are eligible for Medicare, you should:

Be 65 years or older, receive Social Security benefits on
a monthly basis, or have a spouse who receives Social
Security benefits.
 

Be 65 years or younger and receive Social Security
disability benefits during at least the past 24 months.


Suffer from chronic renal failure and require dialysis on a regular basis or a kidney transplant, regardless of age.


Have Lou Gehrig’s disease, which automatically makes you eligible.

 


 

When should I enroll in Medicare Advantage?
 

You are eligible for Medicare Advantage if you:

Are enrolled in Part A and Part B.


Live in Puerto Rico.


Have not been diagnosed with terminal kidney failure.

 

 

Frequently Asked Questions

We have compiled the questions most commonly asked by beneficiaries about Original Medicare and Medicare Advantage, and the answers may be of use should you continue to have doubts. Visit our Frequently Asked Questions page or contact us to guide you MMMore.

 

  • Persons who are eligible for Medicare and Medicaid coverage have “dual eligibility.” A large part of their medical expenses is covered if they have complete Medicare and Medicaid coverage. If you have dual eligibility, you may qualify for a Special Needs Plan (SNP).

     

  • If the enrollment process for Part B is delayed or not completed, the beneficiary may face severe economic penalties imposed by Medicare.

     

  • There are specific periods each year to enroll or make changes to Medicare:

     

    October 15 – December 7

    This is known as the Annual Open Enrollment Period. During this time, members may make changes to their Medicare and Medicare Advantage coverage.

     

    January 1 – February 14

    During this period, better known as Medicare Advantage Disenrollment Period, a beneficiary may cancel his or her Medicare Advantage plan and return to Original Medicare. Should this be the case, the beneficiary may simultaneously choose a separate Medicare prescription drug coverage plan. However, he/she will not be able to switch to another Medicare Advantage plan during this policy year.

     

    Special Enrollment Period

    To qualify for this period of change, you should have met at least one of the following circumstances:

    You just turned 65 years of age.

    Your current plan has been cancelled.

    You have moved to/from Puerto Rico.

    You are eligible for Platino benefits.

    You have moved to a nursing home.

    You receive “additional support” to cover the cost of medicine.

    The Original Medicare or Medicare Advantage contract has been violated.

     

  • Yes. Residents of nursing homes may enjoy the benefits of a Special Needs Plan (SNP). Medicare SNPs are a type of Medicare Advantage plan. Medicare SNPs re limited to people who have specific needs and characteristics, and identify the benefits, providers, medication forms, and other options that best address their healthcare needs.

     

  • Original Medicare was not created to cover all of your medical expenses. This plan covers close to 80% of medical and hospital costs. An Original Medicare plan does not cover prescription drugs. The beneficiary is responsible for all expenses that Medicare does not cover. Medicare Advantage is a viable option to cover those expenses not covered by Original Medicare and receive additional services and benefits.

  • If you are under the age of 65 and have a disability, you are eligible for Medicare Advantage and may be privy to the same benefits that a person aged 65 or older receives. If you have been receiving Social Security benefits for at least the past two years, you may apply to enroll in a Medicare Advantage plan as soon as today. 

     

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