Medicare FAQ

Medicare is a federal health insurance program for people ages 65 or older. Others younger than 65 may also be eligible if they have certain disabilities or diseases, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), otherwise known as Lou Gehrig's disease.

Medicare is also made up of four parts:

• Medicare Parts A (Hospital Insurance) and B (Medical Insurance) - most commonly known as Original Medicare
• Medicare Part C (Medicare Advantage)
• Medicare Part D (Prescription Drug Coverage)

Original Medicare is made up of Medicare Part A and Part B.

Medicare Part A covers most inpatient costs and can include the costs of hospital stays, skilled nursing facility care, and some hospice and homecare benefits

Medicare Part B covers doctor visits, and can include the costs of X-rays, lab tests, chemotherapy and vaccinations.

Medicare Advantage, or Medicare Part C, is a Medicare-contracted plan provided by private insurance companies that replaces original Medicare and offer additional benefits Original Medicare does not cover. Some additional benefits that Memorial Hermann Advantage HMO plans provide are prescription drug coverage, dental, hearing and vision benefits, and a maximum cap on out-of-pocket costs.

Learn more about why a Medicare Advantage plan may be right for you.

You are eligible for Medicare if:

• You are 65 years or older
• You are under the age of 65 and have a qualifying disability
• You are a U.S. citizen or a permanent legal resident; and
• You or your spouse has worked long enough to be eligible for Social Security or railroad retirement benefits - usually having earned 40 credits from about 10 years of work - even if you are not yet receiving these benefits
• You or your spouse is a government employee or retiree who has not paid into Social Security, but has paid Medicare payroll taxes while working

You qualify for a Memorial Hermann Medicare Advantage HMO plan if you are already enrolled in Original Medicare (both Medicare Part A and Part B) and live in the following counties in Texas. In order to qualify for the Memorial Hermann Dual Advantage HMO D-SNP plan, you will also need to be enrolled under Texas Medicaid. For more information regarding dual eligibility, please visit the D-SNP section of our website:

Memorial Hermann Advantage HMO:

• Harris
• Fort Bend
• Montgomery
• Liberty
• Galveston
• Brazoria

Memorial Hermann Advantage Golden Triangle:

• Jefferson
• Hardin

Memorial Hermann Dual Advantage HMO D-SNP:

• Harris
• Fort Bend
• Montgomery
• Liberty
• Brazoria

Memorial Hermann Advantage Prime Value MA Only:

• Harris
• Fort Bend
• Montgomery
• Liberty
• Galveston
• Brazoria

Learn about exceptions to Medicare eligibility.

The biggest difference between Original Medicare and Medicare Advantage is that Medicare Advantage is run by private insurance companies and provides additional benefits that Original Medicare does not cover. For example, Memorial Hermann Advantage HMO plans offer prescription drug coverage, dental, hearing aid and annual vision examination coverage, and a maximum on out-of-pocket costs.

Some plans charge an additional premium for their Medicare Advantage plan, meaning that you pay both your Part B premium and your private insurance plan’s premium each month. With a Memorial Hermann Advantage HMO plan, monthly plan premiums start at $0, and you must continue to pay your required Part B premium every month.

Learn more about the difference between Original Medicare and Medicare Advantage.

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The cost of Medicare Advantage plans varies by plan and by the health services and benefits you will need. To know the full cost, you need to consider cost factors such as whether the plan charges a monthly premium, if there is an annual deductible, what the individual services copays are, what the maximum on out-of-pocket costs are, and whether or not you will need care in or outside of the plan's network.

An insurance deductible is the amount of money you must pay before your health insurance company makes payments toward your health care.

Insurance copay is the amount you pay for a health care service, typically at the time of service. The amount of the copay depends on your plan and the health care service.

An insurance premium is the amount you pay monthly, quarterly or yearly for health insurance. Memorial Hermann Advantage HMO plans start at $0 monthly plan premium and you must continue to pay your Part B premium. Benefits and features vary by plan.

You can enroll in a Memorial Hermann Advantage HMO plan online, by phone, by mail or with the assistance of one of our licensed insurance agents. Refer to our enrollment instructions for more detailed information.

You can enroll in a Medicare Advantage Plan at these times:

• Initial Coverage Election Period (ICEP) - When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
• Annual Election Period (AEP) - Between October 15 - December 7 each year, and your coverage will begin on January 1 of the following year.
• Open Enrollment Period (OEP) - Between January 1– March 31, if you’re in a Medicare Advantage Plan, you can change Medicare Advantage Plans, or leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until March 31 to also join a Medicare Prescription Drug Plan to add drug coverage. Generally, your coverage will begin the first day of the month after the plan gets your enrollment request.
• If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability.

You can also enroll in a Medicare Advantage Plan if you are eligible for a Special Election Period (SEP), for example:

• If you move out of your plan's service area
• If you have been affected by a FEMA-Declared Weather Related Emergency or Major Disaster
• If you were released from jail
• For other special circumstances (such as losing employer group coverage)

Yes, you can help someone else enroll in Medicare or Medicare Advantage if you are a verified authorized representative. The individual you are helping must provide this in written consent. Learn more about helping someone enroll in Medicare.

You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over. (Please note that by clicking on these links, you will be leaving the Memorial Hermann Advantage HMO website.)