Medicare FAQs

Uncover everything you need to know about Medicare with Clever Care Health Plan’s comprehensive FAQ page. From eligibility to coverage options, get your answers here!

What is Medicare?

Medicare is a federal health insurance program that is managed by the Centers for Medicare & Medicaid Services (CMS). It offers coverage for medical and hospital services (Part A and Part B).

However, beneficiaries have the option to sign up for a Medicare Advantage plan, which often includes prescription drug coverage along with supplemental benefits (dental, vision, hearing, and more).

When am I eligible for Medicare?

You are eligible to receive benefits from the federal Medicare program if any of the following situations apply to you:

  1. You are 65
  2. You have End-Stage Renal Disease (ESRD)
  3. You are not yet 65 but have been receiving disability benefits from Social Security to the Railroad Retirement Board (RRB) for 24 months
  4. You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease)

For more information on Medicare eligibility, we recommend that you download a free copy of our Clever Guide to Medicare.

What are my Medicare coverage options?

When it comes to Medicare coverage, there are countless options available. Choosing the right plan depends on your personal needs and budget.

Clever Care Medicare Advisors are available to help find the Medicare coverage option that is best for you.

Call (833) 721-4365 (TTY: 711) to speak to a Medicare Advisor.

What is Medicare Advantage?

Medicare Advantage (also known as Medicare Part C) includes the hospital and medical coverage benefits of Original Medicare (Part A and Part B), plus some additional supplemental benefits.

If the Medicare Advantage plan also includes prescription drug coverage, that’s called a Medicare Advantage and Prescription Drug plan (MA-PD). These plans offer the coverage benefits of Original Medicare (Part A and Part B), along with additional benefits AND prescription drug coverage.

Will Original Medicare cover all my expenses?

Original Medicare will not cover all your medical expenses.

This is why many people will pay for additional supplemental coverage or join a Medicare Advantage plan offered by a private insurance company.

Are prescription drugs covered under Original Medicare?

Yes and No. Part A covers certain medications during hospitalization. Routine prescriptions are not covered. You will need to purchase A Part D plan to cover brand-name and generic prescriptions. Prescription Drug coverage is usually included in a Medicare Advantage plan at no additional cost.

Can I keep my doctor and hospital after I enroll in Medicare?

With Original Medicare you can use any Medicare-approved doctor or hospital. With a Medicare Advantage plan, you are required to use any doctor or hospital in the plan’s network.

When will my Medicare coverage become effective?

The effective date of your Medicare coverage depends on your enrollment date.

If you are enrolling during your Initial Enrollment Period, your coverage begins as early as the first day of your birthday month. If you are switching plans during the Annual Enrollment Period (from October 15 to December 7), your coverage begins on January 1. 

What if I don’t enroll at 65 because I have an employer sponsored health plan?

If you are still working and have coverage through an employer, you may not have to pay a late-enrollment penalty for not signing up at age 65. Talk to your employer benefits administrator.