Medicare Basics: A simple guide for Medicare beneficiaries

Transcription

1 Medicare Basics: A simple guide for Medicare beneficiaries

2 Clover is a whole new kind of Medicare.

3 What s in this guide? Medicare Basics will help you understand some of the basics of Medicare, and some of the options available to you, as a Medicare beneficiary. Ultimately, the choices you make about your own Medicare coverage are up to you. And this guide can give you a solid foundation to help you make these important decisions. Rest assured, we are standing by to answer your questions and assist you in any way we can. 1

4 You have THREE BASIC CHOICES as a Medicare beneficiary. You can rely on Original Medicare alone to provide your coverage. HOWEVER, it s important to know that Original Medicare covers only about 80% of most people s medical expenses. You are responsible for the rest and there is no limit to the out-of-pocket costs you may be required to pay. Original Medicare does not include prescription drug coverage. You can purchase a Medicare Supplement insurance plan in addition to Original Medicare to fill the gaps not covered by Medicare alone. Generally, people with Medicare Supplement insurance plans can see any doctor they want, so they are not limited to a particular insurance plan s network. Medicare Supplement insurance plans do not include prescription drug coverage. For prescription drug coverage, a separate Medicare Part D drug plan must be purchased. You can choose a Medicare Advantage plan (Medicare Part C) to provide all of the benefits you are entitled to under Medicare plus extra benefits. Most Medicare Advantage plans INCLUDE Medicare Part D prescription drug coverage. Medicare Advantage plans, such as Clover, provide these benefits through a contract with the government. With a Medicare Advantage plan, you may have to pay more if you see a doctor or provider who is not in the plan s network. However, with a Medicare Advantage plan, there will be an annual limit to the out-of-pocket costs you pay. 2

5 Original Medicare doesn t cover everything. Original Medicare was not designed to cover all of your health care expenses. And it doesn t include prescription drug coverage at all. 80 % Original Medicare covers about 80 % of your medical expenses. You are responsible for paying the other 20% of your medical costs. Original Medicare generally pays for your hospital care minus a deductible. You are responsible for 100% of your prescription costs. 3

6 Parts of Original Medicare Original Medicare consists of Part A and Part B. Most Medicare beneficiaries pay a premium for Part B coverage. Part A Part A is hospital coverage. Part B Part B is medical coverage. 4

7 Optional Parts of Medicare Medicare Part C and Part D are important options* that can help you pay some of the out-of-pocket costs not covered by Original Medicare. Part C Part C is also known as Medicare Advantage. Part D Part D is prescription drug coverage. * You can get these important Medicare options from Clover. 5

8 Annual Election Period Except under special circumstances, you may only choose or change your Part C (Medicare Advantage) plan or Part D prescription drug plan during certain times of the year. During the Medicare Annual Election, you can join, switch or drop a Medicare health or drug plan for the following year. OCTOBER 1 You may begin receiving plan information OCTOBER 15 Enrollment Period BEGINS DECEMBER 7 Enrollment Period ENDS The choices you make during the Annual Election Period will take effect on January 1 of the upcoming year. 6

9 Special Election Periods You may join a Part C or Part D plan at other times of the year, under certain circumstances, including, but not limited to: When you first become eligible for Medicare. If your current plan is terminated. If you are on both Medicare and Medicaid. If you move to a community not served by your current plan. 7

10 The Advantage of Medicare Advantage Medicare Advantage providers have a contract with the federal government to provide your Medicare benefits in one simple plan, including additional coverage you may need. 8

11 When you join a Medicare Advantage plan, you are still enrolled in Medicare, although you won t have to use your Medicare card to obtain services. Your Medicare Advantage plan will provide your Part A (hospital) and Part B* (medical) coverage and other medically necessary services. Most Medicare Advantage plans include your Medicare Part D prescription drug coverage as well as additional benefits. Because Medicare pays the insurance companies to provide this coverage, Medicare Advantage premiums are generally lower than what you might pay for a Medicare Supplement insurance plan. You ll find that some Medicare Advantage providers offer plans with a $0 monthly premium. * You must continue to pay your Medicare Part B premiums. 9

12 Which type of plan is best for you? Now that you know the basic types of additional coverage available to you as a Medicare beneficiary, you ll be better prepared to make the right choice for your situation. Here s a brief summary: Medicare Advantage plans (Part C) Are provided by companies with a Medicare contract Most INCLUDE prescription drug coverage You may only join during specified enrollment periods Medicare Supplement plans Are NOT a part of Medicare You may join these plans at any time of year, but you may have to answer health questions or take a physical exam to be accepted Do NOT include prescription drug coverage, so you ll probably want to add a Part D plan to complete your coverage * * You may join a Part D prescription drug plan ONLY during specified enrollment periods. 10

13 Clover brings a fresh new approach to your Medicare. 11

14 Compare your options The Annual Election Period is your yearly opportunity to compare your options and choose a Medicare Advantage plan that best meets your needs and budget. To help get you started, here are some things to consider: Does the plan offer a $0 monthly premium*? Are the doctors and specialists that you see included in the plan s network? Does the plan formulary include your prescription drugs? * You must continue to pay your Medicare Part B premium. 12

15 Questions about our plans? Call us toll free: (TTY 711) 8 am 8 pm local time, 7 days/week* Or go online at CloverForMe.com/Guide * Between April 1st and September 30th, alternate technologies (for example, voic ) will be used on the weekends and holidays. Clover Health is a Preferred Provider Organization (PPO) plan and a Health Maintenance Organization (HMO) plan with a Medicare contract. Enrollment in Clover Health depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/ or provider network may change at any time. You will receive notice when necessary. Clover Health es un plan de Organización de Proveedores Preferidos (Preferred Provider Organization, PPO) y un plan de Organización para el Mantenimiento de la Salud (Health Maintenance Organization, HMO) que tiene un contrato con Medicare. La inscripción en Clover Health depende de la renovación del contrato. Esta información no es una descripción completa de los beneficios. Póngase en contacto con el plan para obtener más información. Pueden aplicarse limitaciones, copagos y restricciones. Los beneficios, las primas o los copagos/coseguros pueden cambiar el 1 de enero de cada año. El formulario, la red de farmacias o la red de proveedores pueden cambiar en cualquier momento. Recibirá un aviso cuando sea necesario. Clover Health 는 Medicare 계약을맺은선호서비스제공자기관 (Preferred Provider Organization, PPO) 및종합건강관리기관 (Health Maintenance Organization, HMO) 플랜입니다. Clover Health 가입은계약갱신때마다다시심사되고결정됩니다. 본정보는혜택에대한전체내용이아닙니다. 더자세한정보는 Clover Health 측에문의해주십시오. 제한사항, 자기부담금및제약이적용될수있습니다. 혜택, 보험료및 / 또는자기부담금 / 공동보험료는매년 1 월 1 일에변경될수있습니다. 처방집, 약국네트워크및 / 또는서비스제공자네트워크는언제든지변경될수있습니다. 필요한경우공지를받으시게됩니다. H5141_8EX024F_C