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Medicare Frequently Asked Questions

Frequently Asked Questions about Medicare


If you are new to Medicare or about to become eligible, the Frequently Asked Questions below may provide you with the information you need. We have compiled a list of online resources to point you in the right direction as well.


What is Medicare?

Medicare is the national health insurance program for people age 65 or older, some people under age 65 with disabilities, and for people with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.  The Centers for Medicare & Medicaid Services (CMS) is the federal agency which administers the Medicare program.


What is the difference between Medicare Part A and Medicare Part B?
Medicare Part A (hospital insurance) helps pay for care in hospitals, skilled nursing facilities, hospice care, some home health care and supplies. You are automatically eligible for Medicare Part A when you turn 65 if you or your spouse paid Medicare taxes while you were employed.

Medicare Part B (medical insurance) is optional coverage for which you pay a monthly premium. It helps pay for doctor's services, outpatient care, and other medical services not covered by Medicare Part A. It also helps pay for durable medical equipment and medical supplies, including diabetes testing, ostomy and respiratory supplies and vacuum devices for impotence treatment.


What is Medicare Part C?
Medicare Part C is also referred to as Medicare Advantage Plans. The types of Medicare Advantage plans include Medicare Health Maintenance Organization (HMOs) Plans, Medicare Preferred Provider Organization (PPOs) Plans, Medicare Special Needs Plans and Medicare Private Fee-for-Service (PFFS) Plans.  These plans are available in many areas and often give you more choices, and sometimes, extra benefits, than Medicare Parts A and B.  Everyone who has Medicare Parts A and B is eligible, except those who have End-Stage Renal Disease (certain exceptions may apply).  


What is Medicare Part D?
Medicare Part D was created as a result of the Medicare Prescription Drug Improvement and Modernization Act of 2003. The new benefit means that as of January 2006, Medicare will pay for outpatient prescription drugs through private plans. The enrollment period began on 11/15/05.



What is Medicare supplement insurance?
Medicare supplement insurance is also known as a Medigap policy. It is sold by private insurance companies to fill "gaps" in the Original Medicare Plan (Medicare Parts A and B) coverage.


Purchase a Medigap Plan during your Open Enrollment. The best time to purchase a Medigap policy is during your Medicare open enrollment period (6 months after your enrollment into Medicare Part B). By doing this, companies cannot refuse you coverage because of pre-existing conditions.

If you are receiving Social Security benefits, you may be automatically enrolled. If you are automatically enrolled, you don't need to pay a premium for Part A.


What does Medicare cover?

Medicare covers health care services and items that are medically necessary and reasonable as follows:

  • Medicare Part A-Covers inpatient hospital stays, in patient skilled nursing facility stays, home health care, and hospice care.
  • Medicare Part B: Covers outpatient medical services such as doctor visits, diagnostic lab test and preventative care.
  • Medicare Part D: Covers most prescription.

Why do some people delay enrollment in Medicare Part B?

If you are covered by an employer group health plan due to active employment (i.e. not a Retiree plan), you may delay enrolling in Part B.


Why do some people delay enrollment in a Medicare Part D plan?

If you have creditable prescription drug coverage (meaning it is as good as or better than the standard Medicare Part D drug benefit), you may decide not to enroll in a Medicare Part D plan or to enroll later.

Well with Medicare Parts A and B it is always best to contact your local Social Security office to make sure those Parts are put in place and ready to start. As for the insurance that goes along with Origial Medicare, this is where we come in. Contact an agent today to see how we can help.

    Texas Healthcare Specialists, Inc. is not connected with or endorsed by the United States Government or Federal Medicare Program. We do not offer every plan available in your area. Any information we provide is limited to those plans we provide is limited to those plans we do offer in your area. Please contact or call 1-800-MEDICARE to get information on all your options.

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