Choosing a Medicare advantage Plan Medicare Made Clear TM Get Answers Series Look inside to: understand Medicare advantage (Part C) plans find out about cost sharing learn how to enroll Y0066_140417_151113 Accepted
What is Medicare Advantage? Medicare Part C plans are usually referred to as Medicare Advantage plans. These plans are offered by private insurance companies and allow you to get all the coverage Original Medicare (Parts A and B) offers, plus additional medical services all in a single plan. Many Medicare Advantage plans include prescription drug coverage, often for no additional premium. And some plans also include extra benefits, such as routine vision, hearing and dental care, wellness services and a nurse phoneline. 2 MedicareMadeClear.com
Medicare choices. Step 1 Enroll in Original Medicare when you become eligible. Original Medicare Covers hospital stays + Covers doctor and outpatient visits Government-provided Step 2 If you need more coverage, you have choices. Option 1 or Option 2 Keep Original Medicare and add: Medicare Supplement INSURANCE Medicare Advantage (Part C) Combines Parts A & B Covers some or all of the costs not covered by Parts A & B Offered by private companies and/or Additional benefits Medicare Part D Most plans cover prescription drugs Covers prescription drugs Offered by private companies Offered by private companies Choosing a Medicare Advantage Plan 3
Enrolling in a Medicare Advantage plan. When can I enroll in a Medicare Advantage plan? Before you can enroll in a Medicare Advantage plan, you must sign up for Medicare Part A and Part B. You can first enroll in a Medicare plan during your Initial Enrollment Period, which is a seven month time span that includes the three months before the month you turn 65, your birthday month, and the three months after your birthday. If you don t enroll during your Initial Enrollment Period, you may have to wait to enroll during the Open Enrollment Period, which is October 15 December 7. If you enroll later, your premiums could be higher. your eligibility month three months before three months after Initial Enrollment Period How do I enroll? Each private insurance company that offers a Medicare Advantage plan handles its own enrollment. Most companies provide options to enroll over the phone, online or through a meeting with an agent. To find out how to enroll, contact the company directly or visit Medicare.gov. How does renewal work? Your plan renews automatically each year as long as you pay the premium and the plan is still available in your service area. You don t have to do anything to get continued coverage, but make sure that plan is still the best plan for you. 4 MedicareMadeClear.com
How do I get started choosing a plan? 1Visit Medicare.gov to see which plans are available in your area. You can also call the Medicare Helpline. Medicare s list of plans includes contact information. You can call each plan and ask for more information. 2Compare costs. Look at the premium amount (if any) you ll pay each month. Then estimate your total cost sharing for services. Find a Medicare Advantage plan where the maximum out-of-pocket spending limit, fits your budget. 3Look at the network. If the plan has a network, make sure it gives you access to the doctors you want to see. 4Decide if you want prescription drug coverage. If you want both prescription drug coverage and a coordinated care Medicare Advantage plan like an HMO, HMO POS or PPO plan, choose one with prescription drug coverage built in. You can t combine a stand-alone prescription drug plan with a coordinated care Medicare Advantage plan. Choosing a Medicare Advantage Plan 5
Different types of Medicare Advantage plans. There are several kinds of Medicare Advantage plans. Coordinated Care Plans Health Maintenance Organization (HMO) plans HMO Point-of-Service (HMO POS) plans Preferred Provider Organization (PPO) plans Special Needs Plans (SNP) Other Plans Private Fee-For-Service (PFFS) plans Medical Savings Account (MSA) plans In four kinds of Medicare Advantage plans HMO, HMO POS, PPO and Special Needs Plans your care is coordinated. This means the plan may coordinate your coverage through a primary care physician. With these plans, you may have to choose specific doctors and hospitals. This is different from Original Medicare (Part A and Part B), where you can visit any doctor or hospital that accepts payment from Medicare. The other two types of plans Private Fee For Service (PFFS) plans and Medical Savings Accounts (MSA) plans do not use coordinated care. With these plans, you can get care from any provider who is willing to accept the plan s terms, conditions and payment rates each time they provide covered services to you. Tip Plans vary based on where you live, so make sure you understand what plans are available in your area. 6 MedicareMadeClear.com
What providers can I see with a Medicare Advantage plan? The providers you can see will vary depending on the specific plan. Under the four coordinated care plans (HMO, HMO POS, PPO and SNP), you may have to choose specific doctors and hospitals within a network, or you may risk paying more. In other Medicare Advantage plans, you can get care from any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan before providing service. In addition, most Medicare Advantage plans have service areas, which affect which providers you can see. A service area is the area, typically a county, state or region, in which a plan offers coverage. All Medicare Advantage plans offer nationwide coverage for emergency care, urgent care (care provided outside a doctor s office or emergency room for conditions that require immediate attention) and renal dialysis. Choosing a Medicare Advantage Plan 7
Your share of Medicare Advantage costs. With Medicare Advantage plans, the company that offers the plan sets the premium and decides on the cost sharing. Look at the details of each plan you re considering to see what your share of the cost (cost sharing) could be. How does cost sharing work with Medicare Advantage plans? Most Medicare Advantage plans use a combination of deductibles, coinsurance and copays to share the costs of your care with you. These cost sharing arrangements will usually apply to all of the services the plan covers hospital stays, doctor visits, drug coverage if you have it and so on. Before you choose a plan, make sure the costs fit into your budget. Is there a limit to what I can be asked to pay out-of-pocket? Yes. Limits on your cost sharing is another way that Medicare Advantage plans differ from Original Medicare (Part A and Part B). Many Medicare Advantage plans offer a feature that caps your out of-pocket spending (out-of-pocket maximum) for cost sharing expenses like copays and deductibles in any given year. This provides financial protection in case of catastrophe or medical emergency. Is there a deductible for prescription drug coverage? Some Medicare Advantage plans have a deductible for prescription drug coverage, while others don t. Look at the specific plan for details. Tip Your costs will vary from plan to plan. Shop around for a plan that works well for you. 8 MedicareMadeClear.com
Resources Where can I get more information? Medicare.gov can show you the plans available in your area as well as provide contact information. The Medicare Helpline can answer your Medicare questions. Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048. For help with questions about buying insurance, choosing a health plan, buying a stand-alone prescription drug plan or Medigap policy, and your rights and protection under Medicare, call your State Health Insurance Assistance Program (SHIP). This program offers free counseling for decisions about Medicare coverage. Your local office can also help you locate detailed information about the Medicare Advantage plans, drug plans and Medicare supplement policies available in your area. In some states, this program is called the Health Insurance Counseling and Advocacy Program (HICAP). Choosing a Medicare Advantage Plan 9
Key terms. Coinsurance A kind of cost sharing where the costs of your care are split between you and your plan on a percentage basis. For example, a Medicare Advantage plan might pay 80% and you would pay 20%. Medicare Advantage plans set their own terms about coinsurance. Look at the plan for details. Copay A kind of cost sharing where you pay a preset, fixed amount for each service. For example, in a Medicare Advantage plan, you might pay $7 for each prescription you fill. Many Medicare Advantage plans charge copays. Look at the plan for details. Deductible A kind of cost sharing where you pay a preset amount before the plan begins to provide coverage. Some Medicare Advantage plans charge deductibles and some don t. Look at the plan for details. Maximum out-of-pocket limit A limit that Medicare Advantage plans set on the amount of money you will have to spend out of your own pocket in a plan year. All Medicare Advantage plans have a maximum out-ofpocket limit. Medicare Part A and Part B don t have this feature. Premium A fixed amount you have to pay to participate in a plan. If you enroll in a Medicare Advantage plan, you will continue to pay your Part B premium and your Part A premium, if you have one. The plan may also charge its own premium, though some Medicare Advantage plans do not. Premiums for Medicare Advantage plans can vary widely. Insurers can change premiums and other plan terms from year to year. Each fall, insurers announce the next year s premiums and other terms of their plans. 10 MedicareMadeClear.com
Notes Choosing a Medicare Advantage Plan 11
Interested in learning more? Check out MedicareMadeClear.com to watch videos, sign up for our newsletter, take quizzes, fi nd tools and get answers to your Medicare questions. stay informed: twitter facebook youtube newsletter additional information resources: Visit Medicare.gov Call 1-800-MEDICARE (1-800-633-4227), tty 1-877-486-2048, 24 hours a day, 7 days a week Call your state health insurance assistance Program (ship) to see if you qualify for any fi nancial assistance MedicareMadeClear.com Copyright 2014 United HealthCare Services, Inc. All rights reserved. No portion of this work may be reproduced or used without express written permission of United HealthCare Services, Inc., regardless of commercial or non commercial nature of the use. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan s contract renewal with Medicare. 14_14 SPRJ17700