CHM and Medicare (part 1): An overview of Medicare
Part 1: An overview of Medicare
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.” But what does that look like? How does CHM work alongside Medicare?
Below are common questions the CHM staff receives regarding Medicare and CHM as a supplement. The first few questions define Medicare terms so everyone understands the subject similarly.
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 inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers certain doctors’ services, medical equipment and preventive services.
The CHM Guidelines state that members eligible to participate in Medicare 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 a supplement and secondary to the payment made by your Advantage Plan, so bills your plan doesn’t pay (that are eligible according to the CHM Guidelines) can be shared.
Should I join Medicare Part D for prescriptions?
The decision to join additional Medicare programs is up to you. Medicare Prescription Drug Plans (Part D) may be helpful to CHM members who take multiple routine medications. Joining Part D may not be necessary if you have a Medicare Advantage Plan because some of them include prescriptions (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 for people to use CHM as a supplement to Medicare?
Yes, there are thousands of members who participate in both Medicare and CHM.
Read Part 2 of this article.