What is Medicare?

What Is Medicare?​

Original Medicare was created in 1966 to provide medical insurance to American citizens over the age of 65 or with certain qualifying disabilities. Since it’s inception, Medicare now insures over 65 million Americans and has added additional coverage.

What is Original Medicare?

Original Medicare consist of two parts:

 Part A:  Inpatient hospital and skilled nursing services

 Part B:  Outpatient services, doctor visits, durable medical equipment, and some preventive care

What is Medicare Advantage (Part C)?

Medicare Advantage plans are all-in-one managed care plans approved by Medicare but operated by private companies. They are also known as replacement plans as these plans will replace your Original Medicare benefits. While Medicare Advantage was approved for enrollment in 1997, they became a viable option in 2007.

What is Medicare Part D?

 Medicare Part D, added in 2006, is prescription drug coverage for Medicare eligible individuals. These benefits, available as a stand-alone or embedded in a Medicare Advantage plan, provide assistance with paying for self-administered medications.

What is a Medicare Supplement plan?

Medicare Supplement plans, also referred to as Medigap, have been in existence since 1966. These plans provide financial assistance to cover the gaps in Medicare. These plans reduce your exposure to deductibles, coinsurance and copays found in Original Medicare (Parts A and B).

Check out 10 things that people typically don't realize about Medicare.

Your Medicare Card

Once you’re automatically enrolled in Original Medicare, or you enroll yourself, Social Security mails your Medicare card to the address on file with the Social Security Administration.

This card is for Medicare Parts A and B only.  You’ll receive an additional card if you enroll in a Medicare Advantage, a Medicare Supplement or a Part D prescription drug plan.

Star Ratings

A Five-Star Quality Rating System was developed by the Centers for Medicare & Medicaid Services (CMS) to measure the experience of Medicare beneficiaries when using their respective health care systems and health plans.

The purpose of the Five-Star Quality Rating System is to track and monitor the performance of each plan, including the general care provided by physicians, hospitals and other providers, as well as identify areas of success and those needing improvement.  Star Ratings apply to Medicare Advantage and Part D plans only.

CMS evaluates plan performances annually and releases new star ratings in October, which apply to the following calendar year.

Ratings range from one to five, with five being the highest and one being the lowest in quality performance.

CMS measures how well each plan performs by conducting an annual comprehensive review based on the results of the following categories:

RATING CATEGORIES

Staying healthy: An analysis of the efforts members made to maintain good health, including routine check-ups, vaccines and screening tests.

Managing Chronic (long-term) conditions: An analysis of the efforts members made to manage existing conditions, including treatments and tests recommended by their physicians.

Member Experiences with the health plan: An analysis of the overall member satisfaction of the plan.

Member complaints and changes in the health plan’s performance: An analysis of the frequency that CMS discovered problems with the plan, the frequency of member complaints and decisions to leave the plan, and any improvements of the plan.

Health plan’s customer service: An analysis of how well the plan handled the appeals of members.

RATING SOURCES

The data that CMS utilizes to measure each of these categories is acquired through:

member surveys performed by Medicare

information and input from clinicians

information submitted by the respective plans

results from routine Medicare monitoring activities

RATING CATEGORIES

  Drug plan customer service: An analysis of how well the plan handled the appeals of members.

✓  Member complaints and changes in the drug plan’s performance: An analysis of the frequency that CMS discovered problems with the plan, the frequency of member complaints and decision to leave the plan, and any improvements of the plan.

✓  Member experience with the plan services: An analysis of the overall member ratings of the plan.

✓  Drug safety and accuracy of drug pricing:  an analysis of the plan’s pricing information and the safety measures taken when prescribing medication to members with medical conditions.

RATING SOURCES

The data that CMS utilizes to measure each of these categories for Part D is acquired through:

member surveys

billing information submitted to Medicare by each plan

results from routine Medicare monitoring activities

Why Trust Star Ratings

Star ratings can be a beneficial resource to you as a consumer when comparing health plans in your service area.

After you review and consider all additional factors, such as coverage, costs and the network of physicians and pharmacies, we recommend you also use the plan’s star ratings from CMS to help you make your final decision when choosing a Medicare Advantage and/or Part D plan that’s right for you.

Where To Find Star Ratings

Star Ratings for your current Medicare Advantage or Prescription Drug Part D plan can be found by calling 1-800-MEDICARE or going online and using the Medicare’s Plan Finder tool.

Need help finding the Star Rating for your plan? Schedule a time to speak to one of our local, licensed agents today and we can provide you the information you're looking for.

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