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Medicare Basics

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When It Comes to Coverage, You Have Options

Medicare is a federal health insurance program that is available to people 65 and older, people under 65 with certain disabilities and people with end-stage renal disease. When you are ready to decide on a plan, take the time to understand how the plans work. That way, you can make an informed decision and choose the plan that is right for you. 

You have the choice of your Medicare coverage. There are two primary options, Original Medicare and Medicare Advantage (also known as Part C).

What are the parts of Medicare?

Original Medicare is a fee-for-service health plan managed by the federal government that has two parts: Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). For drug coverage, you can join a separate Medicare drug plan (Part D).

Learn more about the individual parts of Medicare:

Part A - Hospital Coverage
Helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care

Part B - Medical Coverage
Helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds and other equipment)
  • Many preventive services (like screenings, shots/vaccines and yearly "Wellness" visits)

Medicare Advantage (also known as Part C)

  • An "all in one" alternative to Original Medicare that includes Part A, Part B and, usually, Part D.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Most plans offer extra benefits that Original Medicare doesn't cover such as vision, hearing, dental and more.

Part D - Prescription Drug Coverage
Helps cover:

Part D plans are run by private insurance companies that follow rules set by Medicare.

What are Medicare Advantage plans?

A Medicare Advantage Plan is another way to get your Medicare Part A (hospital insurance) and Part B (Medicare insurance) coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies that are approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A and Part B coverage, excluding hospice care. Most plans also include drug coverage (Part D). Medicare Advantage plans often offer coverage for things Original Medicare doesn't cover, such as vision, hearing, dental, and fitness programs (like gym memberships or discounts).

There are different types of Medicare Advantage plans. The most common types of plans include:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans (PDF)
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

Find a Medicare Advantage plan that may be right for you. 

Mahalagang impormasyon

Mga Espesyal na Pangangailangan o Special Needs

Ang Wellcare Special Needs Plans (SNPs) ay iniakma upang matugunan ang mga pangangailangan ng mga taong:

  • Kwalipikado para sa Medicare
  • Nabubuhay sa limitadong kita
  • Kwalipikado para sa Medicaid

Kung kwalipikado kayo para sa isang SNP, puwedeng kasama sa plano ninyo ang mga sumusunod:

  • Saklaw sa ospital, doktor at inireresetang gamot
  • Mga serbisyo sa pamamahala ng pangangalaga
  • Saklaw para sa regular na pangangalaga sa paningin at ngipin
  • Tulong sa pagbabayad ng mga bagay-bagay gaya ng mga bitamina, mga first aid supply, at dental na produkto
  • Tulong papunta at galing sa mga medikal na appointment ninyo

Maaaring may SNP ang Wellcare na nakakatugon sa inyong mga pangangailangan. Depende ito sa inyong antas ng Medicaid. Makipag-ugnayan sa Amin upang alamin pa ang tungkol sa mga SNP.

Mga Disclaimer

‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

Ang Wellcare ang brand ng Medicare para sa Centene Corporation, isang HMO, PPO, PFFS, PDP na plano na may kontrata sa Medicare at isang aprubadong Sponsor ng Part D. Ang aming mga D-SNP na plano ay may kontrata sa programang Medicaid sa estado. Ang pagpapatala sa aming mga plano ay nakadepende sa pag-renew ng kontrata.

Washington residents: “Wellcare” is issued by Wellcare of Washington, Inc.

Washington residents: “Wellcare” is issued by WellCare Health Insurance Company of Washington, Inc.

Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc.

Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc., a subsidiary of Centene Corporation.

“Wellcare” is issued by WellCare Prescription Insurance, Inc.

Bawat taon, sinusuri ng Medicare ang mga plano batay sa 5-star na sistema sa pag-rate.

Walang obligasyon ang mga wala sa network/hindi kinontratang tagapagkaloob na gamutin ang mga miyembro ng Plano, maliban sa mga emergency na sitwasyon. Tawagan ang numero ng aming customer service o tingnan ang inyong Katibayan ng Saklaw para sa higit pang impormasyon, kabilang ang pagbabahagi-sa-gastos (cost-sharing) na nalalapat sa mga serbisyong wala sa network.

Wellcare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of Georgia, Hawaii, Missouri, and Nebraska. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-866-892-8340 (TTY: 711) for Wellcare No Premium (HMO) in GA or consult the online pharmacy directory at www.wellcare.com/medicare; 1-877-457-7621 (TTY: 711) for Wellcare ‘Ohana No Premium (HMO) and Wellcare ‘Ohana Low Premium Open (PPO) in HI or consult the online pharmacy directory at www.wellcare.com/ohana; 1-833-444-9088 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-800-977-7522 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

Louisiana D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please contact us.

Paunawa: Hindi pananagutan ng TennCare ang pagbabayad para sa mga benepisyong ito, maliban para sa mga naaangkop na halaga ng bahagi sa gastos. Hindi pananagutan ng TennCare ang paggarantiya sa pagiging available o sa kalidad ng mga benepisyong ito. Ang anumang benepisyong hindi kasama sa mga karaniwang benepisyo ng Medicare ay nalalapat lang sa Wellcare Medicare Advantage at hindi ito nagsasaad ng mas pinaraming benepisyo sa Medicaid.

Texas D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Texas Medicaid. Learn more about providers who participate in Texas Medicaid by visiting wellcarefindaprovider.com. For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

Texas D-SNP prospective enrollees: For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

Wellcare Dual Liberty (HMO-D-SNP) Plan

Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal.  This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year.  Your Part B premium is covered by Medicaid.  This plan is available to those who have both Medicare and full Medicaid benefits.  Wellcare uses a formulary.  There is no obligation to enroll.  Please contact Wellcare for details.

When joining this plan:

1.) You must use in-network providers, DME (durable medical equipment) suppliers, and pharmacies.

2.) You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.

3.) You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled.

4.) You must understand and follow our plan’s rules on referrals.

Paano makakakuha ng pagsaklaw sa panahon ng sakuna o lokal na emergency.

Sakaling magkaroon ng emergency o likas na sakuna, ang Wellcare ay nakatuon sa pagtulong sa inyong patuloy na madaling ma-access ang pangangalaga. Kapag may krisis, ginagawa namin ang sumusunod:

  • Payagan ang mga benepisyo ng plano sa Part A at Part B at mga suplemental na benepisyo ng plano sa Part C na maibigay sa mga tinukoy na hindi kinontratang pasilidad (tandaan na ang mga benepisyo sa Part A at Part B ay dapat na ibigay ng mga pasilifdad na sertipikado ng Medicare, alinsunod sa 42 CFR §422.204(b)(3))
  • Buong ipinagpapaliban, mga kinakailangan para sa mga referral ng gatekeeper kapag naaangkop
  • Pansamantalang ibaba ang wala sa network na halaga ng bahaginan-sa-gastos na inaprubahan ng plano sa halaga ng bahaginan-sa-gastos na nasa network
  • Ipagpaliban ang kinakailangang 30 araw na abiso sa mga nagpapatala basta't nakakatulong sa nagpapatala ang lahat ng mga pagbabago (gaya ng pagbabawas sa halaga ng bahaginan-sa-gastos at pagpapaliban ng awtorisasyon)
  • Binibigyang-daan kang mag-fill ng mga gamot nang mas maaga kaysa sa karaniwan para matiyak na mayroon ka ng mga kailangan mo sa panahon ng emergency 

Magkakabisa ang mga pagkilos na ito hanggang sa matapos ang panahon ng pagdedeklara ng emergency. Ang Mga Sakuna/Emergency ay maaaring ideklara ng Pamahalaan ng U.S., ng Pederal na Ahensya sa Pamamahala ng Emergency (Federal Emergency Management Agency, FEMA), o ng Gobernador ng anumang estado.

Sa karaniwan, kaklaruhin ng source na nagdeklara ng sakuna kung kailan matatapos ang sakuna o emergency. Gayunpaman, kung hndi pa rin matatapos ang timeframe ng sakuna o emergency sa loob ng 30 araw mula sa inisyal na pagdedeklara, at kung wala pang tinukoy na petsa ng pagtatapos ang Mga Center para sa Mga Serbisyo ng Medicare at Medicaid (Centers for Medicare & Medicaid Services, CMS) para sa sakuna o emergency, babalik na kami sa normal na operasyon pagkalipas ng 30 araw mula sa inisyal na pagdedeklara.

  • Mga Espesyal na Pangangailangan

    Mga Espesyal na Pangangailangan o Special Needs

    Ang Wellcare Special Needs Plans (SNPs) ay iniakma upang matugunan ang mga pangangailangan ng mga taong:

    • Kwalipikado para sa Medicare
    • Nabubuhay sa limitadong kita
    • Kwalipikado para sa Medicaid

    Kung kwalipikado kayo para sa isang SNP, puwedeng kasama sa plano ninyo ang mga sumusunod:

    • Saklaw sa ospital, doktor at inireresetang gamot
    • Mga serbisyo sa pamamahala ng pangangalaga
    • Saklaw para sa regular na pangangalaga sa paningin at ngipin
    • Tulong sa pagbabayad ng mga bagay-bagay gaya ng mga bitamina, mga first aid supply, at dental na produkto
    • Tulong papunta at galing sa mga medikal na appointment ninyo

    Maaaring may SNP ang Wellcare na nakakatugon sa inyong mga pangangailangan. Depende ito sa inyong antas ng Medicaid. Makipag-ugnayan sa Amin upang alamin pa ang tungkol sa mga SNP.

  • Mga Disclaimer

    Mga Disclaimer

    ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc.

    Ang Wellcare ang brand ng Medicare para sa Centene Corporation, isang HMO, PPO, PFFS, PDP na plano na may kontrata sa Medicare at isang aprubadong Sponsor ng Part D. Ang aming mga D-SNP na plano ay may kontrata sa programang Medicaid sa estado. Ang pagpapatala sa aming mga plano ay nakadepende sa pag-renew ng kontrata.

    Washington residents: “Wellcare” is issued by Wellcare of Washington, Inc.

    Washington residents: “Wellcare” is issued by WellCare Health Insurance Company of Washington, Inc.

    Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc.

    Washington residents: “Wellcare” is issued by Coordinated Care of Washington, Inc., a subsidiary of Centene Corporation.

    “Wellcare” is issued by WellCare Prescription Insurance, Inc.

    Bawat taon, sinusuri ng Medicare ang mga plano batay sa 5-star na sistema sa pag-rate.

    Walang obligasyon ang mga wala sa network/hindi kinontratang tagapagkaloob na gamutin ang mga miyembro ng Plano, maliban sa mga emergency na sitwasyon. Tawagan ang numero ng aming customer service o tingnan ang inyong Katibayan ng Saklaw para sa higit pang impormasyon, kabilang ang pagbabahagi-sa-gastos (cost-sharing) na nalalapat sa mga serbisyong wala sa network.

    Wellcare’s pharmacy network includes limited lower-cost, preferred pharmacies in rural areas of Georgia, Hawaii, Missouri, and Nebraska. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-866-892-8340 (TTY: 711) for Wellcare No Premium (HMO) in GA or consult the online pharmacy directory at www.wellcare.com/medicare; 1-877-457-7621 (TTY: 711) for Wellcare ‘Ohana No Premium (HMO) and Wellcare ‘Ohana Low Premium Open (PPO) in HI or consult the online pharmacy directory at www.wellcare.com/ohana; 1-833-444-9088 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), and Wellcare Assist (HMO) in MO or consult the online pharmacy directory at www.wellcare.com/medicare; and 1-800-977-7522 (TTY: 711) for Wellcare No Premium (HMO), Wellcare Giveback (HMO), Wellcare No Premium Open (PPO), and Wellcare Assist Open (PPO) in NE or consult the online pharmacy directory at www.wellcarene.com.

    Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

    Louisiana D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Louisiana Medicaid. Learn more about providers who participate in Louisiana Medicaid by visiting www.myplan.healthy.la.gov/en/find-provider or www.louisianahealthconnect.com. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid and select the “Learn about Medicaid Services” link. To request a written copy of our Medicaid Provider Directory, please contact us.

    Louisiana D-SNP prospective enrollees: For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website at https://ldh.la.gov/medicaid or www.louisianahealthconnect.com. To request a written copy of our Medicaid Provider Directory, please contact us.

    Paunawa: Hindi pananagutan ng TennCare ang pagbabayad para sa mga benepisyong ito, maliban para sa mga naaangkop na halaga ng bahagi sa gastos. Hindi pananagutan ng TennCare ang paggarantiya sa pagiging available o sa kalidad ng mga benepisyong ito. Ang anumang benepisyong hindi kasama sa mga karaniwang benepisyo ng Medicare ay nalalapat lang sa Wellcare Medicare Advantage at hindi ito nagsasaad ng mas pinaraming benepisyo sa Medicaid.

    Texas D-SNP members: As a Wellcare HMO D-SNP member, you have coverage from both Medicare and Medicaid. You receive your Medicare health care and prescription drug coverage through Wellcare and are also eligible to receive additional health care services and coverage through Texas Medicaid. Learn more about providers who participate in Texas Medicaid by visiting wellcarefindaprovider.com. For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

    Texas D-SNP prospective enrollees: For detailed information about Texas Medicaid benefits, please visit the Texas Medicaid website at www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. To request a written copy of our Medicaid Provider Directory, please contact us.

    Wellcare (HMO and HMO SNP) includes products that are underwritten by WellCare of Texas, Inc., WellCare National Health Insurance Company, and SelectCare of Texas, Inc.

    Wellcare Dual Liberty (HMO-D-SNP) Plan

    Wellcare Dual Liberty (HMO D-SNP) is a Fully Integrated Dual Eligible Special Needs Plan with a Medicare contract and a contract with the New Jersey Medicaid program. Enrollment in Wellcare Dual Liberty depends on contract renewal.  This information is not a complete description of benefits. Contact the plan for more information. Limitations and restrictions may apply. Benefits may change on January 1 of each year.  Your Part B premium is covered by Medicaid.  This plan is available to those who have both Medicare and full Medicaid benefits.  Wellcare uses a formulary.  There is no obligation to enroll.  Please contact Wellcare for details.

    When joining this plan:

    1.) You must use in-network providers, DME (durable medical equipment) suppliers, and pharmacies.

    2.) You will be enrolled automatically into Medicaid (NJ FamilyCare) coverage under our plan and disenrolled from any Medicaid (NJ FamilyCare) plan you are currently enrolled in. All of your Medicaid-covered services, items, and medications will then be covered under our plan, and you must get them from in-network providers.

    3.) You will be enrolled automatically into Part D coverage under our plan, and you will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which you are currently enrolled.

    4.) You must understand and follow our plan’s rules on referrals.

  • Paano makakakuha ng pagsaklaw sa panahon ng sakuna o lokal na emergency

    Paano makakakuha ng pagsaklaw sa panahon ng sakuna o lokal na emergency.

    Sakaling magkaroon ng emergency o likas na sakuna, ang Wellcare ay nakatuon sa pagtulong sa inyong patuloy na madaling ma-access ang pangangalaga. Kapag may krisis, ginagawa namin ang sumusunod:

    • Payagan ang mga benepisyo ng plano sa Part A at Part B at mga suplemental na benepisyo ng plano sa Part C na maibigay sa mga tinukoy na hindi kinontratang pasilidad (tandaan na ang mga benepisyo sa Part A at Part B ay dapat na ibigay ng mga pasilifdad na sertipikado ng Medicare, alinsunod sa 42 CFR §422.204(b)(3))
    • Buong ipinagpapaliban, mga kinakailangan para sa mga referral ng gatekeeper kapag naaangkop
    • Pansamantalang ibaba ang wala sa network na halaga ng bahaginan-sa-gastos na inaprubahan ng plano sa halaga ng bahaginan-sa-gastos na nasa network
    • Ipagpaliban ang kinakailangang 30 araw na abiso sa mga nagpapatala basta't nakakatulong sa nagpapatala ang lahat ng mga pagbabago (gaya ng pagbabawas sa halaga ng bahaginan-sa-gastos at pagpapaliban ng awtorisasyon)
    • Binibigyang-daan kang mag-fill ng mga gamot nang mas maaga kaysa sa karaniwan para matiyak na mayroon ka ng mga kailangan mo sa panahon ng emergency 

    Magkakabisa ang mga pagkilos na ito hanggang sa matapos ang panahon ng pagdedeklara ng emergency. Ang Mga Sakuna/Emergency ay maaaring ideklara ng Pamahalaan ng U.S., ng Pederal na Ahensya sa Pamamahala ng Emergency (Federal Emergency Management Agency, FEMA), o ng Gobernador ng anumang estado.

    Sa karaniwan, kaklaruhin ng source na nagdeklara ng sakuna kung kailan matatapos ang sakuna o emergency. Gayunpaman, kung hndi pa rin matatapos ang timeframe ng sakuna o emergency sa loob ng 30 araw mula sa inisyal na pagdedeklara, at kung wala pang tinukoy na petsa ng pagtatapos ang Mga Center para sa Mga Serbisyo ng Medicare at Medicaid (Centers for Medicare & Medicaid Services, CMS) para sa sakuna o emergency, babalik na kami sa normal na operasyon pagkalipas ng 30 araw mula sa inisyal na pagdedeklara.

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Y0020_WCM_164006E_M Last Updated On: 8/8/2024
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