Medicare Frequently Asked Questions

medicare frequently asked questions

What’s the difference between a PPO and an HMO?

An HMO, or health maintenance organization, gives you access to a network of doctors and hospitals in our service area. You choose a primary care physician (PCP) from our network who will provide most of your care and can help you with appointments you may need to see a specialist. Out-of-network visits are only covered in emergency or urgent situations. If you see an out-of-network provider for routine care, you will be responsible for 100 percent of the cost.

A PPO, or preferred provider organization, lets you receive routine care from any provider who accepts Medicare patients, although you will save money if you see in-network providers. Like an HMO plan, a PPO plan will cover out-of-network emergency or urgent care. Typically out-of-network/non-contracted providers are under no obligation to treat CDPHP Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

When do I apply for Medicare? And what parts do I need?

The Initial Enrollment Period (IEP) is the first time you can sign up for Medicare. You may join Medicare Parts A, B, C and D during this window of time:

  • The 3 months before your 65th birthday

  • The month of your birthday

  • The 3 months after your birthday

How do I enroll in Medicare?
  • You may enroll in Medicare Part A and/or Medicare Part B by:

    • Enrolling online at you click this link, you will leave the CDPHP Medicare website.

    • Calling Social Security at 1-800-772-1213

    • Going to your local Social Security office

  • You may enroll in a Medicare Advantage plan (which covers everything Parts A and B do) by contacting a private insurance company, like CDPHP, directly.

What are parts A, B, C, and D?
  • Medicare Part A (Hospital Insurance)

    • Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  • Medicare Part B (Medical Insurance)

    • Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

  • Medicare Part C (Medicare Advantage Plans)

    • A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage plans provide all of your Part A and Part B benefits.

  • Medicare Part D (Prescription Drug Coverage)

    • Part D adds prescription drug coverage to:

      • Original Medicare

      • Some Medicare cost plans and private fee-for-service plans

        • These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug plans.

Do I still have to pay my Part B premium if I enroll in a Medicare Advantage plan?

Yes, you are still required to pay your Part B premium to Medicare. The cost for Part B is based on your household income and can differ from person to person. Check with Medicare for the amount you will pay for your Part B premium.

What is the difference between Medicare Supplement/Medigap and Medicare Advantage?
  • A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn't cover, like:

    • Copayments

    • Coinsurance

    • Deductibles

  • Medicare Advantage plans must cover all of the services that Original Medicare covers.

  • These Medicare health plans are offered by a private company that contracts with Medicare. Medicare Advantage plans provide all of your Part A and Part B benefits.

  • Most Medicare Advantage plans offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Are there any late enrollment penalties?
  • Part B

    • In most cases, if you don't sign up for Part B when you're first eligible, you'll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10 percent for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Your coverage will start the month after you sign up.

  • Part D

    • The late enrollment penalty is an amount added to your Medicare Part D monthly premium.

    • You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your initial enrollment period (IEP) is over, you go without one of these:

      • A Medicare Prescription Drug plan (Part D)

      • A Medicare Advantage plan (Part C, like an HMO or PPO)

      • Another Medicare health plan that offers Medicare prescription drug coverage

      • Creditable prescription drug coverage

Will I be covered if I travel out of the area?
  • When you are outside the service area or the United States and cannot get care from a network provider, our plan will cover urgently needed services that you get from any provider.

  • Original Medicare does not cover services outside the United States.