Understanding Medicare

At UMass Memorial Health, we understand that every situation is unique and understanding your options for Medicare coverage is important, and often overwhelming. We appreciate that you have many questions and decisions to make and want to be a trusted resource for information regarding options to access Medicare benefits. 

What is Medicare?

Medicare is a federal health insurance program for people aged 65 and older, and people with certain disabilities. Medicare is broken into numerous parts, as described by Medicare.gov and referenced below:

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): 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, or vaccines, and yearly “Wellness” visits)

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Medicare Advantage (also known as Part C) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.

In most cases, you’ll need to use doctors who are in the plan’s network or may need a referral to see a specialist.  Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Medicare Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay a portion of the “gap” between what Medicare covers and the portion of health care costs for which you are responsible under Original Medicare (like your 20 percent coinsurance). Policies are standardized and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.  

Medicare Resource Center

Medicare can be confusing. The UMass Memorial Health Medicare Resource Center can help. If you have questions about Medicare or you’d like to learn about the Medicare plans UMass Memorial Health accepts, call our Medicare advisor at 844-416-1051, TTY: 711. Advisors are available to help you free of charge October 1 to March 31, 8 am to 8 pm, 7 days a week and April 1 to September 30, 8 am to 8 pm, Monday to Friday. Or visit www.ummhealth.org/medicare-resource for helpful information.  

Additionally, you can visit Medicare.gov, call 800-MEDICARE, or your local SHINE Program to get information on options available in your area.