CHM: A great complement to Medicare Part 1: An overview of Medicare
Editor’s note: Most of this information is also available here on the CHM website.
CHM Guideline S says that “members or prospective members of Medicare-eligible age must have Medicare parts A and B to become/remain CHM members with full sharing eligibility.” What does that mean? How does CHM work alongside Medicare?
Below are common questions the CHM staff receives regarding Medicare and CHM.
What is Medicare and who is eligible? Medicare is the federal health insurance program primarily for people age 65 or older. Some younger individuals with disabilities and people with kidney failure may also qualify. Medicare offers varying levels of participation, including Parts A, B, C and D.
What are Medicare Parts A and B? Medicare Part A includes facility charges from inpatient hospital stays, limited care in a skilled nursing facility, limited hospice care and some home healthcare. Medicare Part B covers certain doctors’ services (including charges incurred in the hospital), some medical equipment and preventive services. Editor’s note: CHM staff are not experts in what Medicare does and doesn’t cover. Please visit medicare.gov to make sure you understand exactly what’s covered by Medicare Parts A and B.
The CHM Guidelines state that members of Medicare-eligible age must have Parts A and B to receive full sharing eligibility. For more information on how you might be eligible for reduced Medicare costs, visit medicare.gov, view the “Your Medicare Costs” menu and click the links for “Part A costs” and “Part B costs.”
Medicare vs. Medicare Advantage Plan (Part C) Also known as Medicare part C, a Medicare Advantage Plan is a type of Medicare health plan offered by a private company. By contracting with Medicare, this type of plan provides individuals with all Part A and B benefits.
How does Medicare Part C relate to CHM? CHM is still secondary to the payment made by your Advantage Plan.
Should I join Medicare Part D for prescriptions? The decision to join Medicare part D is yours to make; be aware that you will be penalized if you don’t get Part D coverage in a timely manner. Medicare Prescription Drug Plans (Part D) may be helpful to CHM members who take multiple routine medications. Part D may not be necessary if you have a Medicare Advantage Plan because some of them include Part D (check your plan to learn more).
At the CHM Gold level, incident-related (related to the major medical test or procedure performed) prescription costs are eligible for sharing. However, it’s important to keep in mind that CHM does not share costs from routine, maintenance prescriptions at any membership level (Gold, Silver or Bronze).
Where can I get more information about Medicare? The Medicare Helpful Contacts page is for individuals seeking more information about Medicare, including where to find local contact information and program details.
Is it common to use CHM with Medicare? Yes, there are many members who participate in both Medicare and CHM.
Next month: How does it work for CHM members? (part 2)