HEALTH CARE LIFE GUIDE

MEDICARE

Consider your needs. Explore your options. And make a well-informed decision you can live with — for years.

Reaching Medicare eligibility is a big deal, whether you currently have health insurance or not. This federal health insurance program offers affordable, comprehensive coverage to legal, qualified residents, age 65 and older - and those under age 65 with certain disabilities. There are a variety of benefits and options, though, so it's important to choose the coverage that best meets your needs and budget. This Action Plan is designed to help.

This Action Plan is intended to help you handle a challenging time - and hopefully avoid a few missteps along the way. Please be aware that this is an overview, not a comprehensive blueprint covering every situation.

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ACTION PLAN - THE OVERVIEW

FIRST STEPS

Determine needs and eligibility

  • Use the Medicare Eligibility Tool at www.Medicare.gov to find your enrollment deadline or learn your enrollment options, if disabled.
  • Consider what's important to you - ask yourself:
    • How much can I afford for premiums and/or out-of-pocket costs?
    • Do I want to select my own doctors or health care providers, or choose from a network?
    • Do I care about needing referrals to see specialists?
    • Will I require additional benefits, such as prescription coverage?
    • How far would I have to travel for care, if restricted to a network?
    • Is supplemental coverage to help with expenses not covered by traditional Medicare—such as routine dental care, vision needs, or hearing aids—worth the cost?
    • How much do I travel?

NEXT STEPS

Get educated

  • Learn about the four parts of Medicare:
    • Part A = hospital care/skilled nursing facilities
    • Part B = doctors' care/outpatient care
    • Part C = Medicare Advantage plans
    • Part D = prescription coverage
    Click here to learn more
  • Consider your current health and future needs - do you have a chronic condition or disability?
  • Think about your prescription needs - will you want the lowest cost plan or extensive coverage?
  • Compare benefits under the different parts and determine whether you would prefer Parts A and B (traditional Medicare), or a Medicare Advantage plan (Part C)
  • Find plans in your area - traditional Medicare is offered nationwide, but Parts C and D are provided by private insurers, so availability may vary
  • If you already have coverage, such as Medicaid or retiree health insurance through your employer or union, find out how it will work with each Medicare plan - do not make changes until you have these answers

FINISH UP

Compare and decide:

  • Compare ratings for the available plans - consider how well each performs in keeping members healthy, treatment of sick patients, and ease of getting specialist referrals.
  • Sign up for Medicare before the enrollment deadline - missing it may result in coverage delays and/ or added cost.

 

ACTION PLAN

While the information above suggests actions to take, you may find you need some details to actually carry them out. You'll find them here, along with helpful links, phone numbers or places to go for more information.

Discovering your eligibility:

  • To find out about your age-related or disability-based enrollment options and deadlines, use the Medicare Eligibility Tool.
  • If you're approaching age 65, you can enroll anytime within the three months before or three months after your 65th birthday. Enrolling late may create coverage delays and/or penalties that may add to your premium. Read all about Medicare coverage by downloading this pdf .
  • If you're under age 65 and have a qualifying disability, you may be eligible to enroll prior to age 65. In fact, you may be automatically enrolled after 24 months of disability entitlement.
  • Find out if you are eligible for retiree health coverage from your employer, association, or union. If so, compare the coverage to what you would receive under the different parts of Medicare, keeping in mind that retiree health coverage may provide richer benefits.

Learning About Your Choices:

There are many decisions to be made when selecting which Medicare plan to enroll in. Fortunately, there's also a lot of information and guidance:

Signing Up for Medicare:

While you're automatically eligible for Medicare at age 65, you are not automatically enrolled, unless you're already receiving Social Security, Railroad Retirement Board, or Disability benefits. Automatic enrollment is only for Part A, however. You must still sign up for Parts B, C or D, if you want them.

  • To enroll, call the Social Security Administration at 1-800-772-1213 or visit your local Social Security office. Find it by visiting https://secure.ssa.gov/apps6z/FOLO/fo001.jsp
  • You can enroll in a Medicare Advantage or Part D Prescription Drug plan during the three months prior to and after your 65th birthday; however, after that time enrollment is only available during specified times of the year. Failure to act during these enrollment periods may result in coverage delays and/or penalties that may add to your costs.
  • To avoid missing your enrollment dates and deadline, it's best to get your enrollment information well in advance of your 65th birthday.

UNDERSTANDING MEDICARE

Because different people require different kinds of coverage, Medicare has been designed with a variety of options. It's important to understand the coverage differences before you sign up to ensure you get the coverage that best matches your needs. That starts with this overview.
For more detailed Medicare information, visit www.medicare.gov or simply download the Medicare and You pdf .

The ABCDs of Medicare.

  • Part A (Hospital Coverage) helps pay for hospital care as an inpatient, critical access hospitals, skilled nursing facilities, hospice care, and some home health care.
  • Part B (Medical Coverage) helps pay for doctors' care, outpatient hospital care, some medical services Part A doesn't cover, and some home health care, medical equipment and related expenses when they are medically necessary.
  • Part C (Medicare Advantage) are plans offered by private insurance companies that replace (and sometimes expand) Parts A and B coverage (often called Original Medicare).- Depending on where you live, you may be able to choose from an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PFFS (Private-Fee-For-Service), or MSA (Medical Savings Account).
  • Part D (Prescription Drugs) are plans offered by private insurance companies that cover prescription drugs. Some Part C plans include this coverage as well, or you can enroll in a stand-alone Part D plan.

Original Medicare (Parts A & B) is the same nationwide. Part C plans have similar features and benefits, but different policies on choosing physicians and hospitals.

  • With Original Medicare, you can visit any doctor or hospital in the country that accepts Medicare.
  • A Medicare Advantage HMO gives you access to doctors and hospitals in the plan network - some may also offer an option to visit doctors and hospitals outside the network, at additional cost.
  • A Medicare Advantage PPO allows you to visit doctors and hospitals outside the plan network, but you usually have to pay more.
  • In a Medicare Advantage PFFS plan you can visit any doctor or hospital that accepts the plan's terms and conditions of payment
  • Medicare Advantage plans (HMO, PPO, PFFS) may offer additional benefits such as vision, hearing or dental coverage.
  • All Medicare plans are required to pay for emergency or urgent care when you're away from home.
  • Some Medicare Advantage plans also include prescription drug coverage (MAPD plans).

Medicare Prescription Drug Plans

  • Medicare Part D coverage isn't automatic. - you'll need to enroll in a plan if you want it
  • You may choose a stand-alone plan offered through a private company or have your prescription drug coverage included with your Part C coverage.
  • If you don't choose Part D coverage when you first become eligible, but decide to get prescription coverage later, you may pay a government-imposed penalty on your premium.
  • If you chose Original Medicare or a Medicare Advantage plan without prescription coverage, you may join any stand-alone Medicare-approved Prescription Drug Plan serving your area. Please note that in order to be eligible to pair a stand-alone Part D plan with Original Medicare, you must be enrolled in Part B.
  • Prescription Drug Plans vary in terms of drugs covered and out-of-pocket costs.
  • The government has created guidelines for prescription plans, including spending limits, coverage gaps and standards of benefits.
  • Medicare also offers Prescription Drug Assistance Programs that may help you pay for prescriptions.

The amount you pay for Medicare coverage depends on:

  • Which Medicare plan(s) you choose
  • How often you receive care
  • The prescription drug coverage you have
  • Whether you have other health insurance coverage in addition to Medicare

Why choose a Medigap Plan (Medicare Supplement)?

  • Medicare does not always cover your entire doctor or hospital bill.
  • Medicare Supplement plans are a good way to help cover the gap between what doctors and hospitals charge and the amount that Medicare is willing to pay them for the services.
  • Medicare Supplement plans are available from private insurers - not the federal government - so you pay the premiums for these plans yourself.
  • Medigap coverage is different from Medicare Advantage plans (Part C) - it only works with Original Medicare (Parts A & B).
  • Don't forget to consider a stand-alone Part D plan as part of your coverage if you go this route, to help cover your prescription drug needs.

 

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