Optum Care in New Mexico
Learn how Medicare works.
What is Medicare and who is it used for?
Medicare is a federal health insurance program for people who are 65 years old or older. It's also for those of any age with certain disabilities (physical or mental problems) that last 24 months in a row.
There are two main ways you get Medicare:
- Original Medicare (Part A and Part B)
- Medicare Advantage Plan (Part C)
Some people add Medicare prescription drug coverage (Part D) to Original Medicare.
What does Original Medicare cover?
This chart explains Medicare Parts A and B, the two parts of Original Medicare. Medicare is a federal health insurance program. Part A helps pay for hospital stays and inpatient care. Part B helps pay for doctor visits and outpatient care.OR
What other choices do you have?
You can buy more coverage. Private insurance companies sell different plans that cover different items and services.
The Choice A and Choice B charts below show plans private health insurance companies sell. These plans add coverage to Original Medicare plans.
The Choice A chart explains supplemental insurance, or Medigap plans, that can be added to Original Medicare. You can choose to add just Medigap, or you can add Medigap and Medicare Part D to your Original Medicare plan. Medigap plans help pay some of the costs that Original Medicare doesn’t cover. Medicare Part D plans help pay for prescription drugs.
The Choice B chart explains Medicare Advantage plans. Part C plans combine Parts A and B of Original Medicare. Part D plans often include prescription drug coverage. Medicare Advantage plans have other benefits not offered by Original Medicare.OR
Medicare Advantage: everything you get with Original Medicare, plus more
Medicare Advantage plans cover services that Original Medicare doesn't. And many plans offer much more. See the coverage you could get from a Medicare Advantage plan.
The chart shows health care services covered by three types of plans:
- Medicare Advantage
- Medigap, or supplemental insurance
- Original Medicare
Medicare Advantage, Medigap and Original Medicare all pay for:
- Hospital stays
- Some medical care, like doctor visits
- Preventive services, like flu shots
Medicare Advantage and Medigap both limit your annual out-of-pocket costs. Original Medicare does not.
Medicare Advantage pays for some care that Medigap and Original Medicare do not, including:
- Prescription drugs
- Routine vision coverage
- Routine hearing exam and hearing aid coverage
- Routine dental coverage
Benefits do vary by plan with Medicare Advantage and Medigap.OR
If you are new to Medicare, we can help you understand where and when to start. There are some events and situations to know about. These include:
You don’t have to sign up for Medicare if you already have a health plan. But once you’re able to sign up for Medicare, it’s a good idea to compare your current health plan against a Medicare health plan.
Sometimes the costs are lower and coverage is the same. Sometimes Medicare might be better than your employer coverage, or your spouse’s employer coverage. It doesn’t matter if you are still working or aren’t receiving your Social Security income yet.OR
You have a “window” of time you can sign up for Medicare. It’s called your Initial Enrollment Period. It begins three months before your 65th birthday, includes your birthday month and ends three months after you turn 65.OR
Medicare has identified certain physical or mental problems as disabilities. If you have one of these disabilities, you may qualify for Medicare before age 65.
Your doctor and care team are here to help. We have several resources to help you make the best Medicare choice to take care of your health.OR
Some health problems require special care and attention. You may qualify for Medicare Advantage plans that are designed to support certain chronic conditions or long-term medical problems.
The right health care team can improve your quality of life. We create a personalized plan to help you take care of your health. Think of it as an extra layer of support, encouragement and information.OR
Moving can affect your Medicare. In some cases you may be able to choose a new plan. This is called having a Medicare Special Enrollment Period.
The types of moves included are:
- A move to an area that isn’t in your current Medicare Advantage plan’s service area
- A move within your current plan’s service area that opens up new plan choices
- A move back to the United States after living abroad
- A move into or out of a facility