Welcome to Medicare An educational Medicare guide compliments of the Medicare Welcome Team Y0041_3156_A_15_28071 Accepted (1/7/2015)
qualifies? WO You are almost ready to enroll in Medicare, and we would like to help make the process as easy as possible. This Medicare Guide will help you take an important step toward gaining control of your health care needs and expenses during retirement. Inside, you ll find important information regarding the steps you should take leading up to your Medicare enrollment. Please feel free to contact us if you have any questions. And, be sure to visit our Medicare website created for people like you. You ll find it at www.amerihealthmedicare.com/guide. Ameriealth New Jersey Medicare Welcome Team Be sure to check out the FAQs. You may find answers before you even ask! 3
This quick list of Medicare-related terms will help you better understand the information in this Medicare Guide. Notes As you read through this Medicare Guide, write down your notes and questions. Reference this sheet when you have your in-home meeting, or discuss it over the phone with the Ameriealth New Jersey Medicare Welcome Team. Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. Coinsurance: An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent). Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor s visit or prescription drug. Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. Network: Provider is the general term we use for doctors, other health care professionals, hospitals, and other health care facilities that are licensed or certified by Medicare and by the state to provide health care services. We call them network providers when they have an agreement with our plan to accept our payment as payment in full, and in some cases to coordinate as well as provide covered services to members of our plan. Our plan pays network providers based on the agreements it has with the providers or if the providers agree to provide you with plan-covered services. Network providers may also be referred to as plan providers. Call 1-866-447-9889 (TTY/TDD: 711) 7 days a week, 8 a.m. to 8 p.m. Easy Reference Number: ADG4G4 Visit www.amerihealthmedicare.com/guide for more information. Connect with us on Facebook: www.facebook.com/amerihealth medicare 4 5
Medicare is a federal program that provides health insurance for The four parts of Medicare are labeled A,B,C, and D. Each part covers different health care costs: those 65 and older, or younger individuals who qualify under special circumstances (such as disability). ORIGINAL MEDICARE consists of two parts A and B. Original Medicare may not cover all of your health care needs (such as some dental and vision), so you have the option to purchase additional coverage through a private insurance company like Ameriealth New Jersey. The additional coverage consists of Medicare parts C and D. Part A : ospital Insurance elps cover: Inpatient care in hospitals and skilled nursing facilities, nursing home care, hospice, and home health visits. You re eligible if: You or your spouse paid into Social Security for at least ten years through employment, you are a citizen or permanent resident of the United States and you are aged 65 or older. Your cost: Part A is funded by Social Security payroll taxes and is free for most people who paid Medicare taxes while working. WAT is Medicare? Part B : Medical Insurance A D B C elps cover: Doctor visits, lab tests, outpatient services, and surgeries that don t require an overnight hospital stay, plus some preventive services like annual checkups. It also covers some medical supplies like wheelchairs and walkers. You re eligible if: You or your spouse paid into Social Security for at least ten years through employment, you are a citizen or permanent resident of the United States and you are aged 65 or older. Your cost: Unlike Part A, which is free for most Medicare beneficiaries, you must elect and purchase Medicare Part B for a monthly premium. You may elect for your premium to be paid through your Social Security check or your Railroad Retirement benefit. Most people will pay the standard cost for Part B, but others may not. If your modified adjusted gross income noted on your IRS tax return two years ago is above a certain amount, you may pay a higher Part B monthly premium. This is called an Income Related Monthly Adjustment Amount (IRMAA). Likewise, if you do not elect Part B when you re first eligible for Medicare Part A, you may be assessed a late enrollment penalty if you do not have a qualifying reason for not electing it during your Initial Enrollment Period (IEP). Contact Social Security toll-free at 1-800-772-1213 (TTY: 1-800-325-0778) for more information about Medicare Part A and Part B premiums. 6 7
Part C : Medicare Advantage elps cover: The combined coverage of Medicare Parts A and B, plus added benefits such as fitness programs, routine vision, hearing, dental care, and other wellness discounts. Plans may also include Medicare Part D Prescription Drug coverage. Medicare Advantage plans are offered by private insurance companies and are contracted by Medicare. If you join a Medicare Advantage plan, you still have Original Medicare. Your Part A and Part B coverage are administered by the Medicare Advantage Plan instead of Original Medicare. You re eligible if: You have both Part A and Part B, continue to pay the Medicare Part B premium, reside in the health plan s service area, and do not have end-stage renal disease (ESRD), (exceptions apply). Your cost: Your monthly premium is dependent on the Medicare Advantage plan you choose. Your Medicare Part B premium must also continue to be paid. Choose the type of Medicare Advantage plan that works best for you: ealth Maintenance Organization (MO): MOs use a network of doctors, hospitals, and other health care providers to offer you the most care at the lowest possible cost. You ll have a primary care provider and use network providers in most cases with the use of a referral. Preferred Provider Organization (PPO): PPOs give members the ability to see any doctor they wish, when they wish. You may pay more to see a doctor outside the plan s network. Point-of-Service (POS): A POS has combined characteristics of an MO and a PPO plan, but offers you flexibility to see providers outside of the network. A referral may be required and your care may be coordinated through a primary care physician. Special Needs Plans (SNPs): These plans are for people with a chronic illness, older adults with limited incomes, and those living in nursing homes. Typically, you must have Medicare parts A and B as well as Medicaid to join a SNP plan. Part D : Prescription Drug Plan (PDP) elps cover: Your costs for prescription drugs. You re eligible if: You are entitled to Medicare benefits under Part A or are enrolled in Part B and reside in the health plan s service area, or have VA or TRICARE benefits. Your cost: Depending on the plan you choose, you may have a monthly premium and other cost-sharing like copayments and/or deductibles. You must also continue to pay your Medicare Part B premium. Medicare Supplement Insurance Plans (Medigap) You may have heard about another option to supplement your Original Medicare called a Medicare Supplement Insurance Plan (Medigap). These plans help with the costs you re left with after Original Medicare (Parts A and B) pays its share. Medigap plans are provided by a private insurer and do not include prescription drug coverage. While the monthly premiums are higher, some people choose a Medigap plan to reduce their deductibles, copayments, and coinsurance. These plans are identified by the letters A through N, and each one has a distinct set of benefits. Now it s time to see how the parts come together. 8 9
The choice is yours. There are two ways to get your Medicare coverage: OR 1. Build your coverage piece by piece: 2. Choose an all-in-one Medicare Advantage Plan: Medicare Part A ospital Insurance ospital stays Skilled nursing care Other services Medicare Part B Medical Insurance Doctor visits Outpatient services Other medical expenses Purchase a Medicare Supplement Medicare Advantage : Part C Available through a private insurance company, Medicare Advantage plans include: Part A and B benefits May include extra benefits such as: Vision Dental earing Gym memberships Your choice of: MO plan PPO plan Private Fee-for-Service plan May include prescription drug coverage! Medicare Supplement Medigap plans cover some or all of Medicare: Deductibles Copayments Coinsurance Medicare Advantage plans conveniently combine Part A, Part B, and sometimes Part D, into one cohesive plan. Some perks of having a Medicare Advantage plan include: one bill to pay each month, dedicated customer service representatives, and added extra benefits like fitness and wellness programs. Purchase a Part D Prescription Drug Plan Medicare Part D Prescription Drug Coverage Now you know how the parts of Medicare work, but 10 how will it work for YOU? Let s assess your needs. 11
ere is where you can begin your Medicare journey. The following questions can help you build a foundation for choosing coverage that s right for you and your retirement: Ask yourself... If YES... If NO... Can I afford to pay the health care costs Original Medicare doesn t cover? You will be responsible for: Part A and Part B deductibles A monthly premium for Part B 20% of the amount Medicare approves for the medical services it covers 100% of the cost for services not covered by Medicare Consider joining a Medicare Advantage plan. Your premium could be as low as $0 a month. Costs are generally low and predictable, and could include prescription drug coverage. Another option is to choose a Medigap plan. WERE to begin Do I live out of state for part of the year? Consider a plan that provides coverage anywhere in the United States, such as a Medigap plan or Original Medicare. A Medicare Advantage MO or MO-POS plan may cover you for emergency or urgently needed care worldwide. Do I want coverage for hearing aids, routine eye exams, and dental services? You may want to choose a Medicare Advantage plan that offers these additional benefits at no extra cost. Consider staying with Original Medicare and purchasing a Medicare Supplement Plan. Am I willing to get a referral to see a specialist? Opt for a Medicare Advantage MO plan. Your monthly premium could be as low as $0. You could choose a Medigap policy, available at a higher monthly premium. Am I willing to pay more so that I can receive care from any provider? Consider a Medigap plan. You may have to pay more, but you ll have the option to use doctors and hospitals outside the network. A Medicare Advantage MO plan will keep your costs down as long as you stay in network. ave more questions? The Medicare Welcome Team is ready to answer them. Call today. 12 13
Now is the time to learn about your initial Medicare enrollment. ere s what you need to know: Initial Enrollment Period You have a seven-month window to enroll in Medicare. This includes three months before you turn 65, the month of your birthday, and ends three months after the month you turn 65. If you sign up prior to your birthday, in most cases, your coverage starts the first day of the month of your birthday. owever, if your birthday is on the first of the month, your coverage will start the first day of the month before your birthday. General Enrollment Period If you didn t sign up for Part A and/or Part B when you first became eligible, you can sign up between January 1 and March 31 each year. Your coverage will begin July 1 of that year. Special Enrollment Period (SEP) You can make a change in your coverage when certain events happen in your life, like you move out of the plan s service area, you enroll in Medicaid, or you start to receive Extra elp for your prescription drugs. PART A PART B PART C Important dates to remember: WEN to get started PART D Months BEFORE AFTER Your 65th birthday Months October 15 December 7 Annual Election Period (AEP): Anyone Medicare-eligible can join or switch to a Medicare Advantage plan, Medigap policy, or Part D plan. Change from a plan that includes Part D to one that does not. elpful Tip: Missing your Initial Enrollment Period (IEP) can be costly. Medicare Part A, Part B and Part D all may charge late enrollment penalties if you delay and miss your initial dates to enroll. These penalties will be added to your monthly premium for the duration of your Medicare membership. If you want to sign up for a Medicare Advantage plan (Part C), you can do so during your seven-month IEP. If you want to sign up after your IEP, you ll have to wait until the Annual Election Period (AEP) unless you qualify for a Special Enrollment Period, or the General Enrollment Period. January 1 February 14 Medicare Advantage Disenrollment Period (MADP): If you re unhappy with your Medicare Advantage plan, you can disenroll. At this time, you can enroll in Original Medicare, Medicare Part D, and Medigap. Your benefits will begin on the first day of the next month. 14 15
Your coverage options will change depending on whether you re retired, or still working. Read 1. Are you currently enrolled in Medicare? Review your coverage and budget regularly. Review Medicare plan options in your area. 2. Are you eligible for Medicare and still working? If you are still working and have employer-provided coverage, you should contact your Benefits Administrator to determine if you need to enroll in Medicare Part A or Part B. In certain circumstances, your benefits plan may require you to pay for what Original Medicare would cover if you fail to enroll when you re first eligible. If you are not covered at work, review Medicare plan choices in your area. 3. Are you eligible for Medicare and not working? Review Medicare plan choices in your area. If you d like to cover family members who are not eligible for Medicare, explore the individual health plans in your area. Don t wait to choose a plan. You could face penalties if you miss your enrollment deadline. 4. Are you eligible for Medicare and retiring soon or losing health insurance coverage? Talk with your benefits administrator to find out how Medicare might work with your possible retiree benefits. If retiree coverage isn t available to you, review the Medicare plan choices in your area. If your family is currently on your employer-sponsored plan and not yet eligible for Medicare, advise them to consider COBRA or an individual plan. Remember there is a limited amount of time to sign up without being penalized. through the different scenarios at right and see which one best applies to you. Take into consideration the information above as 16 you learn about enrollment in the next section. 17
It s easy to enroll and we can help! The enrollment process will differ depending on what type of Medicare plan you choose. Enrolling In Original Medicare (Parts A and B) If you re receiving Social Security benefits, you ll be automatically enrolled in Medicare. If you re not, you ll need to sign up for Medicare yourself with the Social Security Administration. You can: Enroll by phone or online with the Social Security Administration Visit the Social Security office nearest you and enroll in person. (Take an original or a certified copy of your birth certificate, W-2 forms for the past two years, and your Social Security card or number.) You do NOT have to be retired to enroll in Original Medicare. If you re still working and have employer-provided coverage, Medicare will be the primary payer for Part A hospital services, but you can delay Part B enrollment without a penalty until you lose your employer coverage. Enrolling In Medicare Part B If you want to delay Part B enrollment, you must decline Part B enrollment during the Initial Enrollment Period (see WEN tab for dates) and return your Part B notice to Social Security. If you are 65 and have COBRA coverage on an employer s policy, you should enroll in Part B. You must sign up for Part B during the first eight months you have COBRA to avoid the late-enrollment penalty in the General Enrollment Period. Enrolling In Medicare Part C (Medicare Advantage) You can join a Medicare Advantage plan as soon as you become eligible for Medicare parts A and B, during your Initial Enrollment Period. But you ll need to be enrolled in Part A and Part B before joining. If you don t join a Medicare Advantage plan during your Initial Enrollment Period, you can join during the Annual Election Period. Each private insurance company that offers a Medicare Advantage plan handles the enrollment process. The Ameriealth New Jersey Medicare Welcome Team is here to help you with any questions you might have: Call 1-866-447-9889 (TTY/TDD: 711) 7 days a week, 8 a.m. to 8 p.m. Easy Reference Number: ADG4G4 Visit www.amerihealthmedicare.com/guide Enrolling In Medicare Part D Prescription Drug Plan If you re entitled to Medicare Part A or enrolled in Part B, you can join Part D during your Initial Enrollment Period. If you miss your Initial Enrollment Period, you will have to wait until the Annual Election Period. Each private insurance company that offers Part D handles the enrollment process. elpful Tip: If you enroll in a Medicare Advantage plan that includes a Part D drug plan (even if you don t take the coverage), you cannot also enroll in a stand-alone Part D plan. You must have your medical and prescription drug coverage from the same insurance plan unless you have VA or TRICARE benefits. OW to enroll 18 19
NJ focused. Questions? The Medicare Welcome Team is here to help. Call, click, or meet with us today: Serving ONLY the Garden State, with deep roots here, we re proud to provide our friends and neighbors with one of the largest PONE networks of doctors and hospitals in New Jersey. Choose the plan To request information by mail, call toll-free 1-866-447-9889 (TTY/TDD: 711) that s just the right fit for you. Ameriealth 65 Preferred MO 7 days a week, 8 a.m. to 8 p.m. If you re looking for affordability, Ameriealth 65 Preferred MO may be the right choice for you. Our plans have low premiums, low copays, access to wellness programs, and much more! Easy Reference Number: ADG4G4 AT OME We can arrange an in-home visit at your convenience. Let us know when you call. Ameriealth 65 Preferred MO Want prescription benefits? Ameriealth 65 Preferred MO may be the plan for you. Get the added benefit of Medicare Part D prescription drug coverage for all-in-one convenience. Ameriealth has been providing New Jersey with access to quality health care coverage and dependable local service for over a decade. Our commitment to providing products of value extends to thousands of local residents, including many of your friends and neighbors on Medicare. WEB Visit www.amerihealthmedicare.com/guide for more information. Facebook f Logo CMYK /.eps Facebook f Logo CMYK /.eps Connect with us on Facebook: www.facebook.com/amerihealthmedicare Our Medicare members enjoy more than just quality benefits. You ll have access to knowledgeable representatives who can answer your questions over the phone. Or, arrange a personal one-on-one meeting at your convenience. Ameriealth? WY 20 21
ere are some of our most frequently asked questions. If you are looking for more answers, just call us and ask! Do I receive a notice about Medicare when I turn 65? If you are already receiving Social Security benefits, you will get information about Medicare in the mail three months before you turn 65. If you are not receiving Social Security benefits, you must actively enroll in Medicare yourself by contacting your local Social Security office. See the back of this guide for contact information. I m 63 and I just lost my job. Can I get Medicare early? Unlike Social Security retirement benefits, you cannot enroll in Medicare early. Unless you have been receiving Social Security Disability Insurance benefits (SSDI) for 24 months or have ESRD or ALS, you must wait until you are 65 to receive Medicare. 22 Will I face a penalty if I wait to enroll in Medicare Part D? Yes. You will have to pay an additional Late Enrollment Penalty if, at any time after your initial enrollment period is over, there s a period of 63 or more days in a row when you don t have Part D or other creditable prescription drug coverage. Will money be taken out of my Social Security check for Medicare? Part A is free for most people. You only have to pay a premium for Part A if you or your spouse have not worked and contributed to Social Security for 40 work quarters (10 years). Most people pay a monthly premium for Part B. You can either write a check to Social Security or have the Part B premium automatically taken out of your Social Security check. My income is low. Are there programs that can help me afford my Medicare premiums? Yes. Every state has Medicare Savings Programs (MSPs) that can help pay your Part B premium. A Medicare Savings Program may also pay Medicare copays and deductibles. You can also see if you are eligible for Extra elp. Extra elp is a federal program that can help pay your Part D prescription drug costs. If I have Medicare, do I need to get coverage from the new health care exchanges? No. You do not need to use the health care exchanges. If you have Medicare, you are insured and you will not face penalties under the provisions of the Affordable Care Act. Where can I get help in choosing coverage? There are government-supported resources that you can visit, including Medicare.gov, which provide information about plans. You can also contact Ameriealth New Jersey to speak with a representative from the Medicare Welcome Team. We will gladly walk you through your decisions and help you determine if a Medicare Advantage plan is right for you. I m turning 65 this year, but I will not be retiring at this point. If I wait until retirement to enroll in Medicare Part B, will I be penalized? If you are still working and have employer-provided coverage, you should contact your Benefits Administrator to determine if you need to enroll in Medicare Part A or Part B. In certain circumstances, your benefits plan may require you to pay for what Original Medicare would cover if you fail to enroll when you re first eligible. If you are not covered at work, review Medicare plan choices in your area. Visit www.amerihealthmedicare.com/guide for more information. 23 FAQs
Important Phone Numbers Centers for Medicare & Medicaid Services 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) www.medicare.gov Available 24 hours a day, seven days a week. Social Security Administration 1-800-772-1213 (TTY: 1-800-325-0778) www.ssa.gov Call or go online 24 hours a day, seven days a week. You can speak directly with a representative Monday through Friday from 7 a.m. to 7 p.m. Ameriealth 1-866-447-9889 (TTY/TDD: 711) www.amerihealthmedicare.com/guide 7 days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail. Easy Reference Number: ADG4G4 Connect with us on Facebook: www.facebook.com/amerihealthmedicare Medicare Welcome Team A salesperson will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-866-447-9889, 7 days a week, 8 a.m. to 8 p.m. (TTY/TDD: 711). You must continue to pay your Medicare Part B premium. 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, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. Ameriealth MO, Inc. is an MO plan with a Medicare contract. Enrollment in Ameriealth MO, Inc. depends on contract renewal. Benefits underwritten or administered by Ameriealth MO, Inc. 2015 Ameriealth New Jersey 5439(01/15)BRO