Medicare Basics

If you need the basics and have questions about Medicare, as most of us do, Brown & Toland Physicians is here to help. We can help you get started and guide you through your next steps.

What is Medicare?

What is Medicare (Part A and Part B)?

What is Medicare Advantage (Part C)?

When can I enroll in a Medicare Advantage Plan?

When can I change my Medicare Advantage plan?

Can I keep my doctor?

Am I eligible to enroll in Medicare?

When can I enroll in Medicare (Part A and Part B)?

What is Medicare Supplement Insurance (Medigap)?

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). It is comprised of four parts:

  • Part A - hospital costs
  • Part B - doctor and outpatient care
  • Part C - Medicare Advantage (combines hospital costs, doctor and outpatient care plus added services, such as eye exams and hearing aids)
  • Part D - prescription drugs

What is Medicare Part A and Part B?

Medicare Part A and Part B is also referred to as Original Medicare. Most people age 65 and older are entitled to premium-free Medicare Part A if they or their spouse have made payroll tax contributions for 10 or more years. (Note: you qualify for Medicare at age 65, even if your Social Security full retirement age is older than 65.) If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month.) If you’re close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits, you’ll need to sign up.

People under 65 and disabled will automatically get Medicare Part A and Part B after they receive Social Security Disability Insurance (SSDI) or certain disability benefits from the Railroad Retirement Board (RRB) for 24 months. People who have ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) will automatically get Part A and Part B the month their disability benefits begin. People who have End-Stage Renal Disease (ESRD) will need to sign up for Part A and Part B.

To learn more, watch the video "Medicare & You: Understanding your Medicare choices."

What is Medicare Advantage (Part C)?

A Medicare Advantage plan (Part C) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all of your Part A and Part B benefits. If you're enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and aren't paid for under original Medicare. Most Medicare Advantage plans include Prescription Drug Coverage (Part D). Brown & Toland Physicians works with many Medicare Advantage plans in the Bay Area.

Learn more about Medicare Advantage plan options.

When can I enroll in a Medicare Advantage Plan?

There are certain times during the year to enroll or make changes in a Medicare Advantage Plan (Part C).

Initial Enrollment Period (IEP): During the seven-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the three months before you turn 65, your coverage will begin the first day of the month you turn 65.

Annual Enrollment Period (AEP): Between October 15 and December 7, anyone Medicare eligible can choose a Medicare Advantage Plan. Your coverage will begin on January 1 of the following year.

Special Enrollment Periods (SEPs): In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples include:

  • You change where you live
  • You lose your current coverage
  • You have a chance to get other coverage
  • Your plan changes its contract with Medicare

When can I change my Medicare Advantage plan?

You may only change plans during Medicare’s Annual Enrollment Period, which runs from October 15 through December 7 for coverage beginning on January 1 of the following year, or during a Special Enrollment Period.

Can I keep my doctor?

If you’re already seeing a Brown & Toland physician, you can stay with us and keep your doctor by choosing a participating Medicare Advantage plan. Brown & Toland partners with several health plans, so you can select a plan that’s right for you. If you don’t have a Brown & Toland physician, you can easily choose a Medicare Advantage plan with one of more than 2,400 Brown & Toland doctors in our network. Find a doctor with Brown & Toland Physicians.

For additional information on Medicare, please call 1.800.MEDICARE (TTY users call 1.877.486.2048) 24 hours a day, 7 days a week, or visit medicare.gov.

Am I eligible to enroll in Medicare?

The general requirements for Medicare eligibility include the following criteria.

Medicare Part A (hospital insurance)

  • people 65 or older
  • people under 65 but qualify due to a disability or other condition
  • people of all ages with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease

Medicare Part B (medical insurance)-optional

  • people 65 or older
  • people under 65 but qualify due to a disability or other condition
  • people of all ages with End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease

Medicare Part C (Medicare Advantage)

  • people entitled to Part A
  • people enrolled in Part B
  • people who live in the service area of the plan
  • people who do not have end-stage renal disease (ESRD), but meet one of the few exceptions.

Medicare Part D (Medicare Prescription Drug Coverage)

  • people who are entitled to Part A and/or enrolled in Part B
  • people who are eligible for Part D
  • people who live in the service area of the plan

When can I enroll in Medicare (Part A and Part B)?

Many people enroll into Medicare when they are first eligible at age 65. If you are not automatically enrolled, you can apply through Social Security during your seven-month Initial Enrollment Period, which is the three months before you turn 65, the month you turn 65 and the three months after you turn 65. During this seven-month period, you can sign up for Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance). To apply, call or visit your local Social Security office, or call Social Security at 800.722.1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 800.325.0778.

If you didn't sign up for Part A and/or Part B (for which you must pay premiums) when you were first eligible, and you aren’t eligible for a Special Enrollment Period (see below), you can sign up during the General Enrollment Period between January 1 and March 31 each year. Your coverage will start July 1. You may have to pay a higher premium for late enrollment in Part A and/or a higher premium for late enrollment in Part B.

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period. If you're covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you're disabled) is working, and you're covered by a group health plan through the employer or union based on that work. You also have an eight-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first. Usually, you don't pay a late enrollment penalty if you sign up during a Special Enrollment Period.

What is Medicare Supplement Insurance (Medigap)?

If you’re enrolled in Medicare Part A and Part B (Original Medicare), Medicare Supplement Insurance (Medigap) can be purchased for an additional cost. It helps pay for some of the costs that Medicare (Part A and Part B) doesn’t cover, such as copays, coinsurance and deductibles. If you have Medicare Advantage, you don’t need Medigap supplemental insurance.

Important note: Please note that you do not receive the benefits of being a Brown & Toland member if you elect this option.

Brown & Toland Physicians works with multiple Medicare Advantage plans. Each is a Medicare Advantage organization with a Medicare contract. These various health plans have a contract with Medicare to offer HMO and HMO-SNP plans. Enrollment depends on contract renewal. The provider network may change at any time. You will receive notice when necessary.

Choose a Medicare Advantage plan, keep your Brown & Toland physician.

Contact one of our health plan partners to learn more:

 

Anthem: 1.855.306.4537  (TTY: 711)

Health Net: 1.800.858.6615 (TTY: 711)

SCAN: 1.877.452.5898 (TTY: 711)

UnitedHealthcare: 1.855.252.0779 (TTY: 711)

or contact Brown & Toland Customer Service.

Medicare Quick Links

Find a Doctor

Medicare Basics

Medicare Step-by-Step

Medicare Plan Options 

Medicare Seminars