Medicare Eligibility and Options

If you are age 65 (or older) or if receiving Social Security disability benefits, you may be eligible for Medicare. Contact the Social Security Administration (1-800-772-1213) 90 days prior to the month in which you turn age 65 to obtain Medicare Parts A and B enrolloment information.

When you become eligible for Medicare Hospital and Medical benefits (Parts A and B), health plan providers offer several kinds of Medicare related health coverage options. There are Medicare Supplement plans, HMO Medicare Supplement plans and HMO Medicare Assignment (Risk) plans.

Medicare Supplement Plans:

Medicare Supplement Plans allow you to use any doctor or facility who accepts Medicare. When you use the services of these providers, the providers bill Medicare. The health plan, in accordance with plan provision, pays after Medicare pays.

HMO Medicare Supplement Plans

HMO Medicare Supplement plans have their own network of hospitals, doctors, skilled nursing facilities and other professionals. Services are usually provided either at a centrally located health care facility or in the private practice offices of plan doctors. You select a primary care doctor from those who participate in the Plan. The health plan bills Medicare when you use the services of the plan. You will get all of the Medicare hospital and medical benefits to which you are entitled through your health plan. And, you retain your own Medicare. This means that if you go outside the plan for hospital/medical services, Medicare will pay for any covered services.

HMO Medicare Assignment (Risk) Plans

HMO Medicare Assignment (risk) plans have their own network of hospitals, doctors, skilled nursing facilities and other professionals. Services are usually provided either at a centrally located health care facility or in the private practice offices of plan doctors. However, plans with risk contracts have "lock-in" requirements. This means that you generally are locked into receiving all covered care from the doctors, hospitals and other health care providers who are affiliated with the plan. If you go outside the plan for services, neither the plan nor Medicare will pay. You will be responsible for the entire bill. The only exception is for emergency services for urgently needed care which you may receive while temporarily away from the plan's service area, and while temporarily away from the plans service area

Medicare Assignment - What Is It?