Skip Navigation

Medicare Basics

Maybe you’re new to Medicare and you want to figure it out, but you’re not quite sure where to begin. Let Health Alliance Medicare show you the way.

What is Medicare?

Medicare is a health insurance program for people 65 and older, those younger than 65 with certain disabilities and those with end-stage renal disease (permanent kidney failure).

Learn More

The A, B, C, Ds of Medicare

The A, B, C, Ds of Medicare

Part A Hospital Insurance

Most people don’t pay a monthly cost (premium) for Part A because they or their spouse already paid for it through payroll taxes. Part A covers:

  • Hospital costs, like room and board, and other inpatient care in the hospital or skilled nursing facilities
  • Hospice care and some home health care

Part B Medical Insurance

Most people pay a monthly cost (premium) for Part B. Part B helps cover medical costs like:

  • Doctor visits and outpatient care
  • Some other medical services Part A doesn’t cover

Part C Hospital and Medical (Also called a Medicare Advantage plan)

Private companies, like Health Alliance, contract with Medicare to offer plans with both Part A and Part B. With most Medicare Advantage plans, you pay a monthly premium. With some plans, Part D (prescription) coverage is also included.

Part D Prescription Drug Coverage

This is an optional program that helps cover your prescription drug costs. Only private companies that contract with Medicare, like Health Alliance, offer Part D coverage. You can buy a Stand-Alone Part D Plan (PDP) or a Medicare Advantage plan including Part D.

How Do I Pick a Plan?

How Do I Pick a Plan?

Think through the seven important topics below. Although answering the questions might not lead you to an exact plan, when you start looking at our offerings, you’ll know what to look for.

Plan Choice Considerations
TopicThings to Consider
Coverage Does the plan cover services you need?
Your other coverage If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
Doctor and hospital choice Are the doctors you want to see accepting new patients? Do you want to choose your hospital and health care providers from a network? Does getting a referral to a specialist bother you?
Prescription drugs Do you need to join a Medicare Prescription Drug Plan? Do you already have prescription drug coverage? If so, what's the plan’s overall star rating? What will your prescription drugs cost under each plan? Does the plan’s formulary cover your drugs? Are there any coverage rules that apply to your prescriptions? Is the pharmacy you use in the plan's network? Are you eligible for a free Medication Therapy Management (MTM) program?
Quality of care Are you satisfied with your medical care? How have the Centers for Medicare & Medicaid (CMS) and other people with Medicare rated your health and drug plan’s care and services?
Convenience Where are the doctor's offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail?
Travel Will the plan cover you if you travel to another state or outside the U.S.?

Remember, we’re always ready to help. Call us. Our reps are available from 8 a.m. to 8 p.m., daily.

What About Prescription Coverage?

Only private companies that contract with Medicare, like Health Alliance, offer Part D coverage. If you take medicine every day, you may want prescription coverage to help pay for your drug costs.

Learn More

Tips for Choosing CoverageBefore you start shopping, think through these three tips. They’ll help you understand what to look for in a prescription plan.


Check that your medicines are covered.

A formulary is a list of covered drugs. The formulary will also tell you what tier (cost group) your drugs belong to and how much you’ll pay. To check our formularies, visit our Forms and Resources section.

Understand the Coverage Gap.

It’s important to understand the coverage gap because with most Medicare plans (no matter if you go with Health Alliance Medicare or another plan), you pay most of your drug costs during this time.

Here’s what you need to know.

Pre-Coverage Gap (Initial Coverage Period)
  • It starts when your Medicare plan becomes active.
  • You get your medicines at affordable copayments until you reach the coverage gap.
Coverage Gap
  • When your total yearly drug costs (this is both what you and your plan pay) reach a certain amount, you enter the Coverage Gap.
  • For 2014, this amount is $2,850. When your total yearly drug costs (both what you and your plan have paid) reach $2,850, you enter the Coverage Gap.
  • During this time you pay 72 percent for all generic drugs and 47.5 percent of the discounted cost for all brand-name drugs until your total pharmacy spending reaches $4,550.
  • In 2014, when your total pharmacy spending reaches $4,550, you leave the Coverage Gap and enter the Catastrophic Coverage Period. During this period, Health Alliance Medicare pays for most of your drug costs. You pay the greater of:
    • 5 percent coinsurance, or
    • $2.55 for Tier 1 or Tier 2 drugs and $6.35 for all other drugs
Post-Coverage Gap (Catastrophic Coverage)
  • In 2014, when your total pharmacy spending reaches $4,550, you leave the Coverage Gap and enter the Catastrophic Coverage Period. During this period, Health Alliance Medicare pays for most of your drug costs. You pay the greater of:
    • 5 percent coinsurance, or
    • $2.55 for Tier 1 or Tier 2 drugs and $6.35 for all other drugs

Look for programs to help you save.

Some plans offer special pharmacy programs that help you manage your meds and save money. Take a look at ours.

Walmart and Sam’s Club

Get Tier 1 prescription drugs at Walmart and Sam’s Club for $0. Tier 1 Preferred Generics include most generic medications. You can get drugs at any of our in-network pharmacies, but you may pay more.

AskForGenerics.org

Generic drugs offer the same value as brand-name drugs, but at a lower copayment. Go to AskForGenerics.org to learn more, or visit Drug Compare to learn what generics are part of your plan.

DailyMed

We offer DailyMed to members who take more than one medication. This program brings pre-sorted dosing packets to your door each month, and it costs you nothing extra—just your plan’s regular drug copayments. For more information about DailyMed, please call 1-855-RX-DAILY (or 1-855-793-2459) or visit DailyMedRx.com.

Medication Therapy Management

If you have a chronic condition and take several meds, we have personalized help to make sure you take your medications just as your doctor prescribed, in addition to answering questions you might have about your meds. And if you're taking more than one med, the program helps make sure you're safe. For more information, call us at 1-866-218-6646, Monday through Friday, 10 a.m.–8 p.m. (Eastern Time). TTY/TDD users call 1-800-367-8939.

Extra Help

You may also qualify for extra help from the federal government. For more information and to see if you’re eligible, contact your local Social Security office, visit ssa.gov/prescriptionhelp or call 1-800-MEDICARE (1-800-633-4227).

Two Ways You Can Get Prescription Coverage

Two Ways to Get Prescription Coverage

1. You can buy a Stand-Alone Drug Plan that covers just prescription drugs.

If you have Original Medicare and a Medicare Supplement plan, you could also choose this option. A Stand-Alone Prescription Drug Plan covers your meds while you get your medical coverage through Original Medicare and your Medicare Supplement plan.

Plans differ by region. Use the Find & Compare button to check out what's available in your area.

2. You can buy a Medicare Advantage plan that includes drug coverage.

If you prefer to have one plan for both your medical and your prescription coverage, you might choose this option. Medicare Advantage plans replace Original Medicare, cover many services and often offer extra programs to help you save money and stay healthy.

Plans differ by region. Use the Find & Compare button to check out what's available in your area. 

Find & Compare Plans

Enroll Online

1. Enter your location
2. Compare your options
3. Enroll

Continue

x

Choose your location

Please choose a location to start finding plans available in your area.

x