Navigating Medicare

What Is Original Medicare?

• Medicare provides health insurance for people 65 and older as well as others with disabilities or certain conditions
• Medicare helps with the cost of health care but doesn’t cover all expenses
• A portion of your Social Security is used to cover the monthly premium for Medicare

There Are Four Parts of Medicare

Enrolling in Medicare

You are automatically enrolled if you receive Social Security benefits and/or Railroad Retirement Board benefits.

You’ll receive an Initial Enrollment Package

• Mailed three months before turning 65
• Month 25 of disability benefits
• Includes Medicare ID card

If you’re not automatically enrolled, you can enroll through the Social Security office

• Online
• Call 1-800-772-1213 (TTY 1-800-325-0078)
• In person at your local Social Security office
• If retired from the Railroad, enroll with the Railroad Retirement Board (RRB) at 877‑772‑5772 (TTY 312-751-4701)

When Do You Enroll in Medicare?

Initial Enrollment Period

There is a seven-month window when you can decide if you want to enroll in Medicare.

• Three months before your 65th birthday
• The month of your birthday
• Three months after your birthday
• For example, if your birthday is April 1, you can enroll January 1 – July 31

You may have a lifetime penalty if you don’t enroll during the initial enrollment period, depending on your current coverage.

Annual Enrollment Period October 15 – December 7

• Every year during this time, you can make changes to your Medicare coverage
• This is generally the only time during the year when you can enroll or switch plans
• Any changes you make will be effective January 1 of the following year

Special Enrollment Period

• Loss of employer coverage
• Change in residence
• Medicare Advantage Prescription Drug plan is no longer available

Open Enrollment Period

• From January 1 to March 31, you may change from one Medicare Advantage plan to another. This option can be used only once during the open enrollment period. 
• Medical Savings Account (MSA) plans are not eligible for the open enrollment period.
• If you have Original Medicare, you cannot change to a Medicare Advantage plan during the open enrollment period. 

You must first enroll in Medicare to be eligible to purchase coverage through Network Health. 

 

What Are the Different Medicare Coverage Options Offered by Network Health?

Preferred Provider Organization – PPO*

• Includes a network of providers
• Members can go out-of-network
• Plans may include prescription drug coverage

Health Maintenance Organization – HMO*

• Includes a network of providers
• Must stay in-network or pay the full cost of services (except emergency and urgent care)
• Must select a personal doctor (also referred to as a primary care practitioner or PCP)
• Generally need a referral to see a specialist
• Point of service option allows the member to go out-of-network at a higher cost

Special Needs Plan – SNP*

There are three types of special needs plans

• The member is eligible for both Medicare and Medicaid
• The member is institutionalized
• The member has a chronic illness
  • Diabetes
  • Congestive heart failure
  • HIV/AIDS
  • Mental Illness

Medical Savings Account – MSA

Combines a high deductible Medicare Advantage plan and a medical savings account

• The MSA plan deposits money into the members account
• Members use this money to pay for health care until the high deductible is met (only Part A and Part B expenses count towards this deductible)
• Once the deductible is met, the plan pays the expenses related to covered services
• Members can see any doctor in any service area
• May not include prescription drug coverage

*Available in specific counties. See our Service Area.

Do you have additional questions?

We can help. Please call our sales advisor team at 800-983-7587 Monday-Friday, from 8 a.m. to 8 p.m.

Are you an employer looking for help explaining Medicare? 

Visit the Employer Resources page to learn how we can bring our Navigating Medicare program to your employees.