Medicare Notebook Helping you make sense of Medicare
Hello! Welcome to your Medicare Notebook Whether you re looking for a change or are new to Medicare, this handy guide gives you clear information, helpful checklists and more. It can help you find a plan you like and that fits your life, so you can enroll easily or switch for good. Thinking of switching to a different plan? Maybe your needs have changed or you re looking for a better value. We ll help you compare options. Check out these Notebook topics: Maximize value, flexibility and savings Consider what else matters to you Take the next steps Turning 65? Caring for someone who s eligible? You may be unfamiliar with Medicare, so we ll start with the basics. Be sure not to miss these Notebook sections: Meet the A, B, C & D of Medicare Take a quick quiz to find the right plan Know when to enroll First, decide what you need To help you choose which Medicare option is right for you, make a list of your health care needs so you can quickly compare plans. Here are a few questions to get you started: Do you need prescription drug coverage? Do you need dental coverage? Do you need vision coverage? Do you need coverage for hearing exams and hearing aids? Would you like 24/7 access to a nurse by phone? Will you need worldwide emergency care? Do you want access to wellness programs or gym memberships? Do you prefer a set monthly premium, or would you rather only pay for the care you need? 1 2
Meet the A, B, C & D of Medicare Good health care means different things to different people, and that s why you ll find a variety of Medicare options. We want to help you understand every aspect so you can make a confident, well-informed choice now and anytime you change plans. Here s the scoop. The four basic plan types are: Original Medicare s basic hospital and medical coverage Original Medicare, which is administered by the federal government, is made up of Parts A and B. It covers certain medical services and supplies in hospitals, doctors offices, and other health care settings. Original Medicare (Parts A and B) Medicare Advantage (Part C) Medicare Supplement Prescription Drug Plans (Part D) Original Medicare is the base level plan. It covers some aspects of your doctor visits and hospital stays, but it wasn t meant to cover everything. That s why you might choose to get additional coverage, available from a private insurance company approved by Medicare. Medicare Part A (Hospital Insurance) helps cover: Skilled nursing care Inpatient hospital stays Hospice care Some in-home care Medicare Part B (Medical Insurance) helps cover: Doctor visits & preventive care Outpatient services Medical supplies Tests and x-rays Explore other options with extra benefits Option 1: Medicare Advantage plans (also known as Part C) combine Parts A and B with added benefits that can include prescription drug coverage for all-in-one convenience. Option 2: Medicare Supplement plans cover some of the expenses not covered by Parts A and B to give you more comprehensive coverage. Option 3: Prescription drug coverage (also known as Part D) helps pay for the medications prescribed by your doctor. You should expect to pay premiums (at least for Part B), deductibles and coinsurance for covered services. And for services and supplies not covered by Parts A or B, you will pay the full amount out of your own pocket. Remember, high medical costs from an unexpected illness or injury can impact your retirement savings. So it s smart to add private Medicare insurance coverage to help protect your financial and physical health. 3 4
Maximize value with an all-inclusive Medicare Advantage plan Maximize flexibility with a reliable Medicare Supplement plan Medicare Advantage (Part C) includes Part A hospital coverage and Part B medical coverage in a convenient, all-in-one plan. Most Medicare Advantage plans also include prescription drug coverage (Part D). Many plans also give you additional valuable benefits, like extra days in the hospital. Some plans even offer dental, vision and hearing coverage, and/or access to wellness and fitness programs. Unlike Original Medicare, Medicare Advantage plans have an annual limit on out-of-pocket costs for medical services. You can choose from a wide range of Medicare Advantage plans to fit your needs and budget, with premiums and copays that are often less than Medicare Supplement plans. With a Medicare Supplement plan, also nicknamed Medigap, you ll still have Original Medicare for Parts A and B coverage. Your supplement will cover many of the out-of-pocket expenses that Original Medicare doesn t cover. This is sometimes called filling the gap. You get the peace of mind that comes from more predictable monthly costs and fewer surprises when you need care. You ll have the flexibility to choose any doctor or hospital that accepts Medicare patients. Your coverage travels with you nationwide, and it s guaranteed for life. Eligible for Medicare & Medicaid? You could get specifically designed coverage with a Medicare Advantage Special Needs Plan, known as a D-SNP. D-SNPs all include prescription drug coverage, and some offer extra benefits to help manage your health conditions such as transportation assistance. Even though plans are administered by private companies, their benefits are standardized by the government in most states with several plan types to fit different needs and budgets. 5 6
Maximize savings with affordable prescription drug coverage You can add a prescription drug plan (PDP) from a private insurance company to cover blood pressure medication, cholesterol drugs, and many others to manage your health. Most Medicare Advantage plans include prescription coverage. PDPs cover generic and brand-name drugs, typically with a lower copay for generics. PDPs must cover common types of drugs, but not specific drugs within each type. Check to see if your prescriptions are in the drug list of PDPs you consider. If you don t sign up for Part D coverage when you first become eligible, you will have to pay a penalty when you do eventually enroll. Take a quick quiz to find the right plan Which Medicare plan is best for you? Think about what matters to you most as you compare coverage types. Out-ofpocket costs Choosing my health care providers Medicare Advantage I d like to keep costs as low as possible, and I m especially interested in low cost options. I don t mind staying within a plan s doctor and hospital network to help control expenses. Medicare Supplement I want protection from more of the out-of-pocket costs not covered by Original Medicare. I want the freedom to choose any doctor or hospital that accepts Medicare patients. You can purchase a PDP by itself or with a Medicare Supplement plan. Enrolling into a PDP plan will cause you to be disenrolled from a Medicare Advantage plan. You cannot have a Medicare Advantage plan and a PDP plan at the same time. Prescription drug coverage I d like to have my prescription and medical coverage all in one plan. I m okay with purchasing a separate drug plan. Extra benefits I m looking for a plan that includes things like dental, vision and hearing coverage. It s more important that my general medical costs are covered. 7 8
Consider what else matters to you As you review your Medicare choices and what kind of coverage each plan provides, you ll want to keep a few more things in mind: Your current health Consider how often you ve been to the hospital lately, whether you have chronic conditions that need constant treatment, and which prescriptions you take. How your health might change You may feel fine now, but there may be serious illnesses that run in your family or other risk factors to consider as you age. Your financial situation Review your retirement savings and your budget to assess what you can afford to pay out of pocket or lose if you re hit with unexpected expenses. Your doctors and hospitals Find out if they accept Medicare and the plans you re considering, and if you ll need to pick a primary care physician within your plan. If you re working past age 65 If you have an existing health plan you may want to keep it until you retire, so ask your benefits administrator how it works with Medicare. Know when to enroll Timing s important when it comes to changing your plan or enrolling for the first time, but it s easy to be prepared if you keep a few things in mind. Turning 65? New to Medicare? You can enroll in Original Medicare anytime from three months before to three months after your 65th birthday. This is called your Initial Enrollment Period (IEP). - 3 months before - - 3 months after - Annual Enrollment Period: October 15 December 7 Anyone who s eligible for Medicare can choose a new Medicare Advantage plan or Prescription Drug Plan during the Annual Enrollment Period (AEP). This is a great time to review your current coverage and switch or add plans if your needs have changed. Special Enrollment Periods You may also enroll in a new Medicare Advantage plan or change your plan anytime outside the AEP if you are: Losing your coverage or retiring Moving out of your plan s area On Medicare and Medicaid Have certain chronic conditions Enroll in Medicare Supplement anytime To help you cover the expenses Original Medicare doesn t, you can enroll in a Medicare Supplement plan year round without waiting for the next AEP. 9 10
Follow these simple do s and don ts It s important to get your Medicare coverage in place at the right time because otherwise you could miss out on benefits or pay a late enrollment penalty. Here s how to stay on top of the situation. Do DO enroll in Medicare Part B when you become eligible Sign up during your Initial Enrollment Period (IEP) or as soon as you retire and lose coverage through your employer. Then you can avoid the late penalty, which is a 10% increase in your monthly premium for every year you delayed getting Part B. DO enroll in optional Medicare Part D, too You re not required to get Part D prescription drug coverage, but as with Part B there s a penalty if you don t enroll when you first become eligible. So even if you don t need it now, think about your future needs and sign up promptly if you want to avoid a permanent penalty. Don t DON T miss out on Medicare Supplement coverage If you leave a Medicare Supplement plan but want to switch back more than a year later, your new premium might be higher. And in some states if you have a pre-existing condition, you might not be allowed to re-enroll. So check your state s rules before giving up your Medicare Supplement plan s guaranteed coverage. Take the next steps Once you understand the Medicare plan types and when to enroll, you re ready to review specific plans and find the best fit for you. It might help to keep these things in mind: Cost Many people look for the lowest premiums, but you should also evaluate deductibles, coinsurance and copayments and how they can add up each year. If you choose a Medicare Advantage plan, its annual out-of-pocket maximum can help limit your expenses. Coverage Look at exactly what each plan includes, particularly if you re interested in getting extra benefits like dental, vision and hearing. Also find out if the doctors, specialists and hospitals you like are part of the plan s network, and whether you need to pay more for out-of-network care. Confidence If you re considering a plan from a private company, check out their reputation. Look for a trusted company with a solid history of providing health coverage solutions, knowledgeable representatives who can give you personal guidance, and a strong network of doctors, hospitals and pharmacies. 11 12
FAQs Will Medicare cover all my medical expenses? No. Original Medicare covers some basic medical expenses, but not all. To help you fill the gaps in coverage, you can choose among a range of plans from private insurance companies. Will Medicare cover my prescription drugs? Original Medicare (Parts A and B) does not cover prescription drugs. However, private insurance companies help cover the costs of generic and brand name drugs through prescription drug plans (Part D) and some Medicare Advantage plans (Part C). Can I keep my doctor when I m on Medicare? With a Medicare Supplement plan, you can use any doctor who accepts Medicare patients. With a Medicare Advantage plan, you can use any doctor who accepts Medicare and is in your plan s network. Can any insurance company offer additional Medicare coverage? No, an insurance company must be approved by the federal government to administer Medicare benefits. How soon can I enroll in Medicare? You are eligible to enroll in Medicare beginning three months before your 65th birthday. When will my coverage start? If you enroll as soon as you re eligible, your coverage will begin as early as the first day of your birthday month. Key Medicare terms Coinsurance An insured person s percentage of the cost of health care services after the deductible has been paid. Copayment or copay The amount a member pays for each doctor visit or prescription; usually the same set dollar amount per service or visit. Deductible The amount of expenses a member may have to pay out of pocket for the calendar year before the plan begins to pay benefits. Drug list or formulary A specific Medicare Part D plan s list of covered drugs, often organized by levels of cost sharing called tiers. Network A health plan s group of doctors, hospitals, pharmacies and others who provide services for plan members. Out-of-pocket maximum The annual total you could pay for expenses covered by your plan; a sum of the deductible, coinsurance and/or copayment amounts. Premium The amount you may pay to maintain your health and/or prescription drug coverage, usually on a monthly basis. 13 14
Take advantage of covered services Many preventive services are covered by Medicare to help guard against disease and detect it earlier at little or no additional cost to you. If you re eligible, Medicare covers 100% of its approved amount for your: One-time Welcome to Medicare visit Annual Wellness visit Abdominal aortic aneurysm screening Alcohol misuse screening Bone mass measurement Breast cancer screening/ mammogram Cervical and vaginal cancer screening Depression screening Diabetes screening Hepatitis C screening HIV screening Laboratory services Lung cancer screening Medical nutrition therapy Obesity screening and counseling Shots for Flu, Hepatitis B and Pneumonia Get ready for your doctor visits Your Medicare benefits include a Welcome to Medicare visit the first year you join, plus an annual Wellness visit every 12 months. Whether you re seeing a doctor for one of these regular visits or for a specific medical concern, you should be prepared to discuss: Your medical history and any recent health changes Which medications you take, including prescriptions, overthe-counter drugs, and herbal and dietary supplements Whether you re experiencing any side effects from your medications What tests, screenings and vaccinations you should schedule for someone of your age, gender and condition Any major life events you ve experienced recently or anticipate happening soon How your daily routine may be changing including diet, exercise and social interactions 15 16
Helpful hints for taking medications You know it s best to take your prescriptions in the right amount at the right time, but sometimes life gets in the way. Here are some hints to help you stay on track: Keep these websites and phone numbers handy There are several resources available to help you. Store your medications in the same place every day, where they re easily accessible Once a day or once a week, depending on how many drugs you take, put your medications into a pill box or organizer that lets you check if you ve taken them Set a reminder alert on your phone, computer or alarm clock Post a note on your calendar and after you ve taken your medications for the day, move the note to the next day Ask your pharmacy if they have an automatic refill program and if you can get a 90-day supply of your medications Take advantage of mail order pharmacy services to get home delivery of your maintenance medications and refills To sign up for Original Medicare (Parts A & B), contact the Social Security Administration: ssa.gov/medicare 1-800-772-1213 (TTY: 1-800-325-0778) For information about Medicare from the Federal Government: medicare.gov 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) 24 hours a day, 7 days a week To find contact information for your state s State Health Insurance Assistance Programs (SHIPs): medicare.gov/contacts/#resources/ships For help understanding your rights and benefits, contact the Medicare Rights Center: medicareinteractive.org 1-800-333-4114 17 18
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