It s Time for Medicare med-ageinbook-1214
Medicare What you need to know. You re turning 65. Or you re already 65 and getting ready to retire and lose your healthcare coverage. You re almost ready for your first Medicare plan. But do you really understand Medicare? If not, it s time to learn. Medicare can be confusing. We can make it easier. What is Medicare? Medicare is a federal health insurance program through the Centers for Medicare & Medicaid Services (CMS). The Social Security Administration started Medicare to help people pay for their health costs if they re 65 or older or have certain disabilities. It is mostly paid for by payroll taxes and premiums paid by Medicare beneficiaries. Medicare has four parts. We ll tell you more about them as we go. Part A Hospital Coverage (inpatient hospital stays, skilled nursing facilities, hospice, some home health care) Part B Medical Coverage (doctor visits, outpatient care, some home health care) Part C Medicare Advantage (you get this from a private company, and it pays in place of Original Medicare) Part D Prescription Drug Coverage Medicare and Medicaid are not the same. Medicare is a federal program, and anyone 65 or older is eligible. Medicaid is a state and federal program and is only for people with limited income. You may be eligible for both.
Who is eligible for Medicare? U.S. citizens or legal residents (for at least five years in a row) who are 65 or older or have certain disabilities. When can I enroll? If you already get a Social Security or Railroad check for retirement, CMS will automatically enroll you in Original Medicare. You don t need to apply. If you don t already get a Social Security or Railroad check, you can enroll during these times. Initial Enrollment Period starts three months before the month you turn 65, includes the month of your birthday and ends three months after the month you turn 65 General Enrollment Period from January 1 to March 31 After a special event, like retirement or moving You don t have to pay a premium for Part A if you ve already paid into it through your (or your spouse s) job for at least 10 years. You have to pay a premium for Part B, and it could be higher if you sign up after your Initial Enrollment Period unless you re still working and get medical insurance through your job. Does Medicare pay for everything? No. Original Medicare only pays about 80 percent of your healthcare costs. If you have questions about any of this, call us. We want to help you. 1-888-382-9771 daily from 8 a.m. to 8 p.m., October 1 to February 14, and weekdays from 8 a.m. to 8 p.m. the rest of the year. TTY users call 711.
Original Medicare Parts A & B The government offers Original Medicare a program that helps you pay for hospital (Part A) and medical (Part B) costs. Here s how it works. Medicare pays for part of the doctor and hospital services you use. You can go to any doctor or hospital that accepts Medicare. Part A Part B Premium Covered Services You Pay No premium for those who paid Medicare taxes (through a job or a spouse s job) for at least 10 years. You pay a premium for Part B each month. Inpatient care in the hospital, skilled nursing care, hospice, home health care. Outpatient care, doctor s visits and services, diagnostic and lab services, durable medical equiptment and more. Medicare Advantage Part C Medicare Advantage plans are optional plans that you can purchase from private insurance companies. If you want all your coverage from one place, like the health plan you may be used to, a Medicare Advantage plan may be right for you. Here are the basics. You must enroll in Parts A and B to sign up for Medicare Advantage. You receive your Original Medicare Part A and B coverage through the Medicare Advantage Plan, and you can choose a plan with Part D (drug coverage). You buy a Medicare Advantage plan from a private company, like Health Alliance Medicare. Medicare Advantage plans have yearly limits to keep your out-of-pocket costs lower. Original Medicare doesn t. There are different types of Medicare Advantage Plans. Health Alliance plans vary by location, but look a lot like plans you might have had through work with a network of doctors and hospitals to use. Check what s available in your area at Medicare.gov. Like plans you ve had before, Part C (Medicare Advantage) plans give you a network of doctors and hospitals. With an HMO plan, you must use these doctors unless it s an emergency. With a PPO plan, you can go out-of-network, but you will likely pay more. Medicare Advantage plans may offer extra benefits that Medicare does not cover. With a Health Alliance Medicare Advantage Plan, you get extras like dental and vision coverage, plus: Assist America global emergency coverage when you travel SilverSneakers membership at participating gyms and workout equipment to use at home Depending on the service, you may pay a deductible as well as copayments or coinsurance.
Prescription Drug Coverage Part D Part D plans are offered through private companies, like Health Alliance Medicare, to help cover your drug costs. You can get your Part D coverage in two ways. Some Medicare Advantage plans include prescription drug coverage or you can also purchase a stand-alone prescription drug plan, often called a PDP plan. PDP plans pair with Original Medicare or Medicare Supplement plans. If you don t enroll when you become eligible for Medicare, you could pay a penalty later, called the Late Enrollment Penalty. If you re still getting drug coverage through your job or another source the government says is as good as or better than Medicare, known as creditable coverage, you won t have to pay the penalty later. Medicare Supplement Medigap You can buy a Medicare Supplement plan from a private company, like Health Alliance Medicare, to help fill in the gaps of Original Medicare. You must enroll in Parts A and B to qualify for Medicare Supplement Plans. Medicare Supplement plans help cover the costs that Original Medicare doesn t cover, like coinsurance, copayments and deductibles. These plans generally only cover services that Original Medicare covers. The government sets the rules, and a private insurance company provides the plan. Insurance companies can only offer standardized policies identified by letters A through D, F through G, and K through N. While you ll find lots of options, each policy covers the same basic services, no matter which company you use. Premiums vary by plan option and company. You can t have both Medicare Supplement and Medicare Advantage.
Time to Choose Original Medicare doesn t cover everything. So you need to decide whether you will purchase additional coverage. Here are your options: 1 2 3 Stay with Original Medicare Alone Parts A and B (hospital and medical). You ll be responsible for the costs that Original Medicare doesn t cover and won t have prescription drug coverage. Original Medicare with Medicare Supplement/Medigap to help pay for the costs Original Medicare doesn t. You must keep paying your Part B premium. You can also choose a Stand-alone Part D Plan to provide prescription Drug Coverage (Part D). You can add this coverage with or without having a Medicare Supplement Plan. You must be enrolled in either Part A or B. Choose a Medicare Advantage Plan. You still have Medicare, but a private company provides your Part A and B coverage. You can choose a plan that offers Part D (or prescription drug coverage). You must keep paying your Part B premium. Original Medicare Medicare Advantage Medicare Supplement Part A (hospital) Yes Yes Yes Part B (medical) Yes Yes Yes Part D (medical) No Yes No Extras services, dental and vision exams and fitness programs Provider Network No Yes No* Can use any doctor who accepts Medicare Yes Can use any doctor who accepts Medicare Premiums Part B only (as long as you paid into Medicare while working) Yes (must pay Part B, too) Yes (must pay Part B, too) What if I m still covered at work? You can keep the health plan you have and enroll in Medicare when you retire. If you keep medical coverage through your job and wait to get Part B, you ll have eight months from when you retire to add Part B without a penalty. If you keep getting drug coverage through your job, you won t pay a penalty if you add Part D later. It s important to talk to your employer before choosing to stay on your group plan or enroll in Medicare. *varies by plan
Things to Think About It s time to think about your needs and what different plans offer. Choose the plan that fits your life and budget. Don t wait. Check networks. You can see ours at HealthAllianceMedicare.org. Click Find a Doctor. Look at your past healthcare costs and see how they line up with different plans. View our plans in the guidebook here and at HealthAllianceMedicare.org. Check drug formularies (lists of covered drugs) to see if a plan covers your drugs. View our formulary in the guidebook or at HealthAllianceMedicare.org. Look for extras, like Assist America. See what Health Alliance Medicare offers in the Extras section of the guidebook and at Why Us? at HealthAllianceMedicare.org. Compare plans. The government rates Medicare Advantage plans on a five-star scale based on quality, value, customer service and more. Check out our Star Ratings at HealthAllianceMedicare.org. Medicare Timeline The Time is Now With Medicare, timing is key. If you miss a deadline, you miss out on coverage and could pay a penalty later. Remember these deadlines: For Parts A, B, C (Medicare Advantage) and D (prescription drugs), you have a seven-month Initial Enrollment Period that starts three months before the month you turn 65, includes the month of your birthday and ends three months after the month you turn 65. For Medicare Supplement (Medigap), you have a six-month period starting the first day of the month you re 65 or older and have Part B. The General Enrollment Period for Original Medicare and Medicare Supplement is January 1 to March 31. The Annual Enrollment Period for Medicare Advantage is October 15 to December 7. (If you already have Medicare, you can make changes at this time.) You can also enroll after a special event, like retirement or moving. Call us to see if you qualify for a Special Election Period. Health Alliance is an HMO, PPO and PDP plan with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premiums and/or copayments/coinsurance may change on January 1 of each year.
Ready to Learn More? Our friendly staff will help you understand Medicare and be here for you every step of the way. Just look at the numbers 96 percent of our members choose to stay with us. Don t miss your time to enroll. When you re ready to take the next step, call us at 1-888-382-9771 daily from 8 a.m. to 8 p.m., October 1 to February 14, and weekdays from 8 a.m. to 8 p.m. the rest of the year. TTY users call 711. Helpful Terms Coinsurance 20% coinsurance means you pay 20%. Health Alliance Medicare covers the rest. Copayment The set dollar amount (like $20) you pay at the doctor s office, pharmacy or hospital. Deductible The amount you pay before benefits kick in. Some plans have separate medical and pharmacy deductibles. Formulary A list of common medicines grouped by drug class (meaning they work in a similar way) or by the medical problem they treat. Health Alliance Medicare generally only covers drugs on your plan s formulary. Network The doctors, clinics and hospitals a health plan works with to provide discounted services to its members. Preauthorization Your doctor must ask Health Alliance before some medical treatments, services and prescription drugs can be covered. Premium The monthly fee you pay for coverage. Provider A doctor, nurse, physician assistant, etc., who you see for health care. Yearly limit The most you will pay in a benefit period, usually a year, before your plan pays 100 percent of covered expenses. Key Phone Numbers Health Alliance Medicare: 1-888-382-9771 (TTY 711) Daily from 8 a.m. to 8 p.m., October 1 to February 14, and weekdays from 8 a.m. to 8 p.m. the rest of the year Medicare: 1-800-Medicare (1-800-633-4227) Social Security Administration: 1-800-772-1213 U.S. Railroad Retirement Board: 1-877-772-5772 med-ageinbook-1214 Y0034_15_28621