A Simplified Guide to Medicare Options Brought to You by 5-out-of-5-Star Medicare Advantage Plans
A Simplified Guide to Medicare Options Table of Contents What is Medicare?... 3 Seven Things to Know About Medicare... 4 Medicare Part A: Hospital Insurance... 5 Medicare Part B: Medical Insurance... 6 Medicare Part D: Prescription Drug Insurance... 7 Comparison and Contrast... 8 Step-By-Step Guide to Choosing a Medicare Plan... 9 Why 5-Star Ratings Matter to Medicare and You... 10 Additional Resources... 11 KelseyCare Advantage wants you to have the health care coverage that is best for you. Choosing the Medicare plan that s right for you is an important decision. That s why we are here to help you. This booklet gives you some information about Medicare. 713-574-5086 KelseyCareAdvantage.com 2
What is Medicare? Medicare is health insurance for the following individuals: People 65 or older People under 65 with certain disabilities People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) The Different Parts of Medicare The different parts of Medicare help cover specific services: Parts A and B make up what is called traditional or original Medicare. Part A is hospital insurance. Part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and home health care. Part B is medical insurance. Part B helps with doctors costs, hospital outpatient care, and home health care. Parts D and C are plans offered by private insurance companies. Part D helps with prescription drug costs. Part D prescription drug plans help cover the cost of prescription drugs. Part C is called Medicare Advantage or MA. Medicare Advantage (like an HMO or PPO) combines Parts A and B, and often, Part D, into one plan. Medicare Advantage plans cover everything that traditional Medicare covers, plus some services that Medicare does not cover. Part A + Part B + Additional Coverage (such as Part D, Vision, Hearing, Dental, and Preventive Services) = Part C (Medicare Advantage) 713-574-5086 KelseyCareAdvantage.com 3
Seven Things to Know About Medicare 1. Ways to Get Medicare Simply speaking, there are two ways to get your Medicare coverage. Traditional Medicare: The first way is to choose traditional Medicare (Parts A and B). Then, if you need prescription drug coverage, you may decide to join a Part D prescription drug plan. You may also want to get additional coverage that fills in the gaps of what traditional Medicare (Parts A and B) doesn t cover. This extra coverage is called supplemental insurance or a Medigap policy. Medicare Advantage Plan: The second way is to choose a Part C Medicare Advantage plan (like an HMO or PPO). Medicare Advantage plans combine Part A (hospital insurance) and Part B (medical insurance), and oftentimes, Part D (prescription drug) coverage, into one plan. If you choose a Medicare Advantage plan, you don t need supplemental coverage. A Medicare Advantage plan helps fill the gaps for what is not covered by traditional Medicare coverage. 2. Share of the Cost Most people pay nothing for Medicare Part A. You already paid for traditional Medicare Part A coverage through the taxes you paid while working. Even with traditional Medicare coverage, you still share some of the costs. You ll pay a Medicare Part B premium. You re also responsible for deductibles, copayments, coinsurance, and your prescription drug cost. 3. Drug Coverage If you choose traditional Medicare, you can buy prescription drug coverage (Part D) from a private company contracted with Medicare. Adding Part D to traditional Medicare usually includes a monthly premium, a deductible, and copays. If you choose a Medicare Advantage plan, prescription drug coverage is often included at no additional cost beyond what you pay Medicare for your Part B premium. 4. Unexpected Costs Medicare Parts A and B do not cover all expenses. There is also no cap on your annual out-ofpocket costs. That s why most consumers choose supplemental or Medicare Advantage coverage. 5. Timing Time is money when it comes to first enrolling in Medicare. Waiting to enroll may result in higher costs and fewer choices. 6. Annual Review Your Medicare needs can change. So, review your coverage once a year. You can change plans during the Annual Enrollment Period at the end of each year. Medicare also offers a 5-Star Enrollment Period for plans rated 5-Stars. You can switch to a 5-Star plan one time each year until November 30th. You don t have to wait for the Annual Enrollment Period to improve your coverage. 7. Assistance Available If you have limited income and resources, you might qualify for help to pay for some health care and prescription drug costs. Call 1-800-MEDICARE (TTY/TDD 1-877-486-2048) for more information. Phone lines are open 24 hours a day, 7 days a week. 713-574-5086 KelseyCareAdvantage.com 4
Medicare by the Letters Medicare Part A: Hospital Insurance Part A helps pay for inpatient hospital, skilled nursing following a hospital stay, and hospice care. ENROLLMENT Joining On the first day of the month that you turn 65, you will automatically receive Medicare Part A coverage. If your birthday is on the first day of the month, Part A will start the first day of the prior month. Signing Up Current Social Security recipients are automatically enrolled. COVERAGE LIMITS Limits do apply to hospitalization and skilled nursing facility stays of more than 90 days at one time. NOT COVERED While in the hospital, Part A does not cover doctor services, personal in-hospital costs, prescription drugs, or custodial care. YOUR SHARE OF THE COSTS Premium Most people do not pay a premium for Part A. Deductible There is a deductible paid before Part A starts covering costs for hospital stays. Copay After a certain amount of days in a hospital, a copay is owed. This increases for longer hospital stays. Coinsurance There is a small coinsurance for inpatient care for hospice patients. 713-574-5086 KelseyCareAdvantage.com 5
Medicare by the Letters Medicare Part B: Medical Insurance Part B helps pay for physician care, outpatient hospital care, lab tests, a few diagnostic screenings, and some skilled-nursing care. ENROLLMENT Joining You re eligible for Part B coverage on the first day of the month you turn 65. However, you can opt out of the coverage, without penalty, if you continue to receive credible health coverage from an employer. If your birthday is on the first day of the month, Part B will start the first day of the prior month. Signing Up Current Social Security recipients are automatically enrolled in Medicare Part B at age 65. For consumers, not taking social security at the time they turn 65, it s different. If they will no longer receive health coverage from an employer, they should enroll in Medicare at least one month before their 65th birthday. Otherwise, they could pay a penalty for the rest of their lives. COVERAGE LIMITS There are limits on some services, such as occupational therapy. Also, health screenings are limited to specific times. NOT COVERED Vision, dental, and hearing are covered in only specific scenarios. Care outside of the United States is not covered. YOUR SHARE OF THE COSTS Premium There is a premium, which may change from year to year and is based on income. Deductible There is a deductible to meet before Part B benefits begin. Copay There are copays for outpatient services. Coinsurance After the deductible is met, Part B usually will pay about 80% of Medicare-allowable rates. 713-574-5086 KelseyCareAdvantage.com 6
Medicare by the Letters Medicare Part D: Prescription Drug Insurance Part D helps with the cost of prescription medicine coverage. It is an optional benefit that requires an extra premium with traditional Medicare. It s included in most Medicare Advantage plans. ENROLLMENT Joining Upon eligibility for Medicare, you may join a Part D plan. You are not automatically enrolled. Signing Up You can join, switch, or drop a Medicare drug plan at these times: When you re first eligible for Medicare If you get Medicare due to a disability Anytime, if you qualify for Extra Help COVERAGE LIMITS Each plan can vary in cost and drugs covered. NOT COVERED All plans cover some, but not all, prescription drugs. YOUR SHARE OF THE COSTS Premium Monthly premiums vary from plan to plan. Deductible Some plans have deductibles, others do not. 713-574-5086 KelseyCareAdvantage.com 7
Comparison and Contrast Do you want traditional Medicare or a Medicare Advantage plan? You can choose traditional Medicare or a Medicare Advantage plan. Traditional Medicare: If you choose traditional Medicare and want prescription coverage, you need to add a Prescription Drug Plan (Part D) through a private company. You ll pay an extra premium. You may also want to purchase supplemental coverage (a Medigap policy) to cover the costs of what traditional Medicare does not pay. Medicare Advantage Part C: Medicare Advantage plans generally cover all of the services that Medicare Parts A, B, and D cover in a single plan. If you choose a Medicare Advantage plan, you make just one decision. Plus, you ll receive more benefits compared to traditional Medicare. And, many Medicare Advantage plans have no premium beyond what is paid for Medicare Part B. Traditional Medicare (Parts A & B) with Additional Insurance Policies Medicare Advantage (Part C) A Single Policy Part A: Hospital Part B: Doctor & Outpatient Care (premium paid to Medicare) Part D: Prescription Drugs (extra premium) Part C: Medicare Advantage (includes Part A & B. Often no premium beyond the Part B premium paid to Medicare) Part D: Prescription Drug coverage (can be included for no additional cost beyond what is paid for Part B.) Medicare Supplemental Insurance for what is not covered by Parts A+B (extra premium) 713-574-5086 KelseyCareAdvantage.com 8
Step-By-Step Guide to Choosing a Medicare Plan Step One: Research Your Options Resources include the Medicare website, www.medicare.gov, and the Texas Department of Aging and Disability Services. Step Two: Evaluate Your Current State of Health Overall Health: Are you in relatively good health, or do you face health challenges? Prescription Drugs: Which medications, if any, do you take? What are the monthly costs of these prescriptions? Doctors: What doctors do you see and how often? Travel: Do you travel out of the country? How often? Cost: On average, how much are your medical costs? Budget: What can you afford? Do you need financial aid? How much unexpected cost can you withstand? Retirement Coverage: Does your former employer contribute to your health plan expenses? Step Three: Customize Plan Do you want traditional Medicare? Can you afford extra premiums for supplemental coverage? Or, do you want a Medicare Advantage plan with or without a drug plan? Consider the star rating that Medicare gives the plan for satisfaction and healthy outcomes. Step Four: Get Help Extra Help is available. Many people qualify to get Extra Help to pay for their Medicare prescription drug costs, but don t know it. If you didn t automatically qualify for Extra Help for prescription drugs, you can apply through the U.S. Social Security Administration. Step Five: How to Enroll in Medicare New to Medicare: Enroll as soon as you turn 65 and are eligible. For the majority of people, enrollment opens three months before the month you turn 65, continues during your birthday month, and three months after your birthday month. Already a Medicare Beneficiary: You have a chance to change your coverage in the Annual Enrollment period. During this period you can join, switch, or drop a Medicare Advantage plan. The Annual Enrollment Period is October 15 through December 7 each year. Already have a Medicare Advantage Plan: If you re in a Medicare Advantage plan, you can leave your Medicare Advantage plan and switch to traditional Medicare between January 1 and February 14 each year. Special 5-Star Enrollment Period: Provides more options and flexibility for switching plans outside of Open Enrollment. You can switch to a 5-Star plan one time up until November 30th. 713-574-5086 KelseyCareAdvantage.com 9
Why 5-Star Ratings Matter to Medicare and You Medicare now rates Medicare Advantage plans to help consumers evaluate them. Each plan gets ratings from one to five. A 5-star rating is considered excellent and less than 2 ½ percent of all Medicare Advantage plans in the country have this rating. Some factors that align with higher Star ratings These ratings help you compare plans based on quality and performance. According to a recent report, Assessing the 2017 Medicare Advantage Star Rating by McKinsey on Healthcare, the top three areas influencing ratings include: HD4 Member Complaints and Changes in the Health Plan s Performance HD2 Managing Chronic (Long Term) Conditions HD1 Staying Healthy: Screenings, Tests and Vaccines KelseyCare Advantage provides the only 5-Star Medicare Advantage plans in Houston with a 5-Star rating for both medical and drug coverage. (Nationally, less than 1% of all Medicare Advantage plans are rated 5-star for both.) Special 5-Star Enrollment Period No Waiting Medicare makes it easy to improve your Medicare coverage NOW during the special 5-Star Enrollment Period. If you re enrolled in Medicare, you can take advantage of this option once a year until November 30th. You can sign up one month with a 5-Star Medicare Advantage plan and be enrolled the very next month! Don t wait to get a 5-out-of-5-Star rated Medicare Advantage plan. Call 713-574-5086 (TTY/TDD 1-866-302-9336) to speak with a Health Plan Specialist. 8 a.m. to 8 p.m., Monday Friday, February 15 to September 30 and 7 days a week, October 1 to February 14. 713-574-5086 KelseyCareAdvantage.com 10
Additional Resources Medicare For questions about Medicare: Phone: 1-800-MEDICARE (1-800-633-4227) (TTY/TDD 1-877-486-2048) These phone lines are open 24 hours a day, 7 days a week. Website: www.medicare.gov U.S. Social Security Administration For Medicare eligibility, enrollment, and financial aid; Social Security retirement benefits; or disability benefits questions, use this contact information: Phone: 1-800-772-1213 (TTY 1-800-325-0778) KelseyCare Advantage Please contact us with any questions or comments. You can reach us by phone, online or through the mail. Phone: 713-574-5086 (TTY/TDD 1-866-302-9336) Website: www.kelseycareadvantage.com Mailing Address: 11511 Shadow Creek Pkwy. Pearland, Texas 77584 Website: www.ssa.gov U.S. Administration on Aging For finding local, state and community organizations serving elder adults and their caregivers: Phone: 1-800-677-1116 Website: www.eldercare.gov Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. KelseyCare Advantage is an HMO Medicare Advantage organization with a Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. You must continue to pay your Medicare Part B premium. 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. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-866-535-8343 (TTY: 1-866-302-9336). ATENCIÓN: se habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-535-8343 (TTY: 1-866-302-9336). 2017 KelseyCare Advantage. All rights reserved. 713-574-5086 KelseyCareAdvantage.com 11
Call 713-574-5086 (TTY/TDD 1-866-302-9336) 8 a.m. to 8 p.m., Monday Friday, February 15 to September 30 and 7 days a week, October 1 to February 14. KelseyCareAdvantage.com H0332_17KCDTPD Accepted