Medicare Questions

Frequently Asked Questions

• About Medicare 
• About Aetna Medicare Advantage Plans
• About Aetna Medicare
  Rx^® Plans (PDP)

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About Medicare

Here are frequently asked questions about Medicare. To see an answer, simply click on that question. 

General

1. Who is eligible for Medicare?
2. How do I apply for Medicare?
3. What is the Medicare Modernization Act?
4. What are the basic parts of the Medicare program now?
5. When can I switch Medicare health plans?
6. What’s the difference between traditional Medicare and Medicare prescription drug coverage?

1. Who is eligible for Medicare?

   You are eligible for Medicare if you:

   • Reach age 65 and are entitled to monthly Social Security benefits.
   • Are age 65 or over and have a spouse entitled to Social Security benefits, even if you are not.
   • Are age 65 or over and are the widow or widower of someone who was entitled to Social Security benefits.
   • Are under age 65 and have received Social Security disability benefits for at least 24 months.
   • Are entitled to Social Security benefits and need maintenance kidney dialysis or a kidney transplant, regardless of your age.

    

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2. How do I apply for Medicare?

   When you meet one of the eligibility requirements, simply sign up for Social Security benefits and your Medicare card will be sent to you in the mail. Many people sign up during the three months prior to their 65th birthday. However, other rules apply if you:

   • Collected Social Security benefits before turning age 65.
   • Work past age 65.
   • Are eligible for Medicare because of a disability.
   For more information, contact Social Security at 1-800-772-1213 (TTY/TDD: 1-800-325-0778) Monday through Friday, 7 a.m. to 7 p.m., or visit the Social Security Administration website at www.ssa.gov.

    

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3. What is the Medicare Modernization Act?

   The Medicare prescription drug program and the changes to Medicare offered through private insurance companies, now known as Medicare Advantage, are the result of the Medicare Modernization Act. In 2003, Congress passed a new law to bring people with Medicare more choices in health care coverage and better health care benefits. This law preserves and strengthens the current Medicare program and adds important new preventive benefits. It also adds a prescription drug benefit (Medicare Part D) that Medicare beneficiaries may purchase from a private insurer. The prescription drug benefit also provides extra help to people with low incomes.

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4. What are the basic parts of the Medicare program now?

   • Part A (Original Medicare Plan) is managed by the federal government to cover inpatient hospital and skilled nursing facility care, home health agency services and hospice benefits — usually for no monthly premium.
   • Part B (Original Medicare Plan) is managed by the federal government to cover doctor services and outpatient care for a low monthly premium, which is deducted from your Social Security check.
   • Part C (Medicare Advantage Plans) is offered by companies like Aetna, who contract with the federal government, to cover the same or better benefits than the Original Medicare Plan (Parts A and B). Some Medicare Advantage plans include Medicare prescription drug coverage (MA-PD plans), others do not (MA plans).
   • Part D (Medicare prescription drug coverage) is offered by companies like Aetna, who contract with the federal government, to help cover your prescription costs only. This coverage is available as a Medicare prescription drug plan (PDP) or as part of a Medicare Advantage plan (MA-PD).
   • Medigap (Medicare Supplement Plans) is offered by companies like Aetna to help pay for certain benefits not covered by Original Medicare (Parts A and B). New Medicare Supplement policies no longer cover prescription drugs.

      

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5. When can I switch Medicare health plans?

   Generally, you can only make plan selections or changes to your current Medicare coverage during certain times of the year. During the annual enrollment period from November 15 through December 31, anyone with Medicare can choose a new Medicare health and/or prescription drug plan for the new plan year. This is also the time that anyone with Medicare can make changes to their current coverage.

   Medicare Advantage plan members have an additional, yet more limited, ability to make another choice, if eligible, between January 1 and March 31. Read about examples of possible changes.

   Generally, you may not make any other changes during the year unless you meet certain special exceptions for a special election period (SEP). These exceptions include moving out of the plan’s service area, or you have Medicaid coverage.

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6. What’s the difference between traditional Medicare and Medicare prescription drug coverage?

   Original Medicare — Parts A and B — covers hospitalization and outpatient medical services. Most prescription drug coverage was not included in the Original Medicare plan. With Medicare prescription drug coverage (Medicare Part D), individuals can receive a prescription drug benefit through the Medicare program.

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