Discover Medicare

Learn about Medicare

Medicare is a federal government program that provides health insurance for people age 65 and over or those under age 65 with certain disabilities.

The Centers for Medicare and Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes paid by people who are working.

While also a government program, Medicare is not the same as Medicaid or Social Security.

  • Medicaid is a state-provided health insurance program for those with limited income.
  • Social Security provides benefits and assistance to retired people and to those who are unemployed or disabled.

Medicare and Social Security are linked. Both serve people are 65 and over as well as those receiving Social Security Disability Insurance due to a disability. To enroll in Medicare, you must sign up through the Social Security Administration. 

randmother With Grandson At Home Looking Out Through Window To Garden

Eligibility

Who is eligible for Medicare? Generally, people who are:

  • Age 65 and over
  • Under age 65 with a qualifying disability; or
  • Age 21 and over who qualify due to end-stage renal disease

There are premiums for Medicare insurance. If you have a limited income, you may qualify for a program called Extra Help to pay for your monthly plan premium and prescription drugs.

Medicare Has Four Parts

red icon of hospital
PART A
Covers hospital insurance
blue icon of stethoscope
PART B
Covers medical insurance, like doctor visits

In addition to Part A and Part B (Original Medicare) you have the option to purchase:

  • Part D, a separate prescription drug plan
  • Supplemental insurance, sometimes called MediGap or MedSupp plans

MediGap and MedSupp plans usually cover items such as:

  • copayments
  • coinsurance
  • deductibles
  • health care you get outside the U.S.

They usually don’t help cover:

  • vision care and eyeglasses
  • hearing aids
  • dental care
  • long-term care
  • private-duty nursing

Original Medicare does not cover expenses incurred by you if you are traveling outside of the United States, even if it is an emergency. Medicare Advantage plans typically have coverage for foreign travel outside the United States and Medicare Supplement plans may cover foreign travel as well. Another option is to replace Original Medicare with a Medicare Advantage plan.

green icon of shield

PART C
Medicare Advantage Plans

purple icon of pill bottle

PART D
Helps pay for prescription drugs

Part C, Medicare Advantage

  • Can be purchased from private insurance companies such as Virginia Premier
  • Combines Part A and Part B into one plan for full coordination of your care and usually includes a Part D prescription drug plan
  • Provides everything that Original Medicare covers and can also include additional benefits like dental, hearing, vision, wellness services and a nurse phone line

To be eligible for Medicare Parts C and D you must:

  • Reside in the approved service area;
  • Have Parts A and B; and
  • Not be diagnosed with end-stage renal disease

Get the most from Medicare with a Dual Eligible Special Needs Plan (D-SNP)

D-SNPs are Medicare Advantage plans that offer:

  • more coverage than Original Medicare.
  • extra benefits at no extra cost.
  • a dedicated care coordinator.

Frequently Asked Questions

I am still working and on my employer’s health insurance plan. When I turn age 65, do I need to sign up for Part B during my Initial Enrollment Period?

No. You can wait until you are ready to retire and move off your employer plan or your spouse’s insurance plan if that is an option. When you do so, you will be eligible for a Special Enrollment Period and have an eight-month window to sign up for Part B. The eight-month period begins when your employer or union coverage ends or when your employment ends, whichever is first. Be sure to elect Part B at that time so you don’t have to pay a late enrollment penalty. That penalty is 10% a year for late enrollment.

If I am covered by Medicare, is my spouse automatically covered as well?

No. Medicare is an individual enrollment. Both you and your spouse must sign up for separate coverage and the policies are not related. There is no family coverage under Medicare.

If I enroll in Medicare Parts A and B with Social Security, do I also enroll for Part D prescription drug coverage?

No. Part D is not related to your Original Medicare coverage. It is additional coverage for prescription drugs your doctor prescribes. You must enroll with a private insurance plan that contracts with Medicare. You have two choices: You can take Original Medicare and then sign up for a Part D plan, or you could enroll in a Medicare Advantage Part C plan that has prescription drug and medical in an all-in-one plan.

When I decide to enroll in Medicare and choose a Medicare Advantage plan, do I need to stay with the same insurance company I had with my employer?

No. When you leave your employer and no longer have health insurance coverage, you can choose a Medicare Advantage plan from any company that offers service in your area. You also can stay in Original Medicare and buy a Medicare Supplement plan and a Part D prescription drug plan.

Health insurance counseling is available

If you have questions, check with your State Health Insurance Program — the Virginia Counseling and Assistance Program (VICAP). VICAP offers free unbiased, confidential counseling on health insurance, education and assistance to seniors and adults with disabilities and their families. This program can help in understanding Medicare and making decisions about prescription drug plans, Medicare Advantage plans, Medicare Supplement plans or long-term care insurance.

How can I reach VICAP?

Write to:
Virginia Division for the Aging (DARS)
1610 Forest Avenue, Suite 100
Richmond, VA 23229

Toll-Free: 1-800-552-3402 (Nationwide Voice/TTY)
Phone: 1-804-662-9333
Fax: 1-804-662-9354
E-mail: aging@vda.virginia.gov

Resources

By logging in to this portal, I affirm that I have read, understand and agree to abide by the following terms and conditions: 

I certify I am a health care provider, an employee of a health care provider, a business associate of a health care provider, or an employee of a business associate, and the purpose of my access to any Virginia Premier System is related to the provision or payment of health care services.

With respect to all information viewed or obtained from this site, I agree to comply with all applicable federal and state laws regarding the confidentiality and integrity of health and medical records. This includes full compliance with the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), the HITECH Act, and the Virginia Health Records Privacy Act, and applicable regulations to these laws.

I agree to keep confidential all information related to Virginia Premier System business, including, but not limited to, quality and risk management activities as well as other confidential or personal information concerning the medical, personal, or business affairs of Virginia Premier System and its members.

I agree to notify Virginia Premier System immediately in the event that my network access has been compromised in any way and in the event of unauthorized use or disclosure of any information obtained from the Virginia Premier System network.

Need to register for a new account? Click here.

In order to register for an account, if you would like access to all group NPIs/APIs under a single Tax ID, please enter your Tax ID only. If you would like access to a specific group NPI/API instead, please enter it in the field provided. 

For expedited registration, please provide a Claim number and the Total Billed Charges on the claim when creating your account.

You will receive an email within 3-5 business days with your username and temporary password.

Please call Technical Support for help with Virginia Premier’s Provider Portal at 1-877-814-9909 or email connect@healthtrio.com. 

Virginia Premier is offering EFT services through PaySpan.

Please click here to sign-up

If you have questions or need help please, contact our Provider Services department at vphpnetdev@virginiapremier.com or by calling 804-968-1529.