Medicare Basics

First, a few basics about Medicare

Medicare is the federal health insurance program for people who:

  • are aged 65 and older
  • are younger than 65 who have some disabilities, or
  • who have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). **

Medicare has two parts:

  • Part A Helps pay for inpatient hospital stays, critical care, skilled nursing facilities, hospice care and some home health care. Those who worked or whose spouse worked and paid Medicare taxes automatically qualify for Part A when they become eligible. There is no premium for Part A. There are out-of-pocket costs for you.
  • Part B Helps pay for doctors' services, outpatient hospital care, physical therapy, occupational therapy and home health care that is not covered under Part A. You do pay a premium for Part B. There are also out-of-pocket costs for you. You must be enrolled in Part B to be eligible for Medica Medicare Solutions® plans. You can check your red, white and blue Medicare care to see whether you are entitled to Part A and/or Part B.

As a Medicare beneficiary, you can choose from different Medicare plan options. One is a Medicare Cost Plan like the Medica Prime SolutionSM (Cost) Plan. Another is a Medicare Advantage plan like the Medica Advantage SolutionSM Private-Fee-For-Service (PFFS) Plan.

If you have certain types of chronic conditions or have both Medicare and Medicaid, you may qualify for a third type of Medicare plan called a Medicare Special Needs Plan. Medica offers two Special Needs Plans: Medica DUAL Solution® (HMO SNP) for beneficiaries who have both Medicare and Medicaid; and Medica Complete Solution® (HMO SNP) for beneficiaries who have Chronic Lung Disease, Dementia or Diabetes, Cardiovascular Disease and Heart Failure.

** If you have End-Stage Renal Disease (ESRD) and you are in the Original Medicare plan, you may join a Medicare Prescription Drug Plan, but you usually can't join a Medicare Advantage Plan. If you have had a successful kidney transplant, you may be able to join a Medicare Advantage Plan. If you have questions about eligibility and ESRD please contact Medica at 952-992-2345 or 1-800-906-5432.


H2410_H2450_H2458_H3283_H7526_2620
CMS Approved (12/29/2011)
Last Updated: November 2011