| Q. |
What is Medicare? How does it work? |
| A. |
Medicare is a federal health care program, managed
by the Centers for Medicare & Medicaid Services (CMS),
which provides health insurance to retired individuals
and certain people with disabilities regardless of
medical condition. Original Medicare is a
fee-for-service plan with two components, Medicare Part
A and Medicare Part B. Alternatives to traditional
Medicare coverage include Medicare Advantage plans.
Medicare Part A provides coverage for hospital bills
(inpatient hospital care, hospice care, and home health
care). This is financed by payroll taxes, with no
premium to beneficiaries who have at least 40 quarters
of Medicare-covered employment. The beneficiary pays a
$992 deductible for hospital stays up to 60 days, with
additional copays required for stays longer than 60
days.
Medicare Part B provides coverage for doctor bills
(physician care as an inpatient at a hospital, at a
doctor's office, or as an outpatient at a hospital or
other health care facility) laboratory tests, physical
therapy, and ambulance service. The Medicare Part B
beneficiary premium is $93.50 per month. Medicare Part B
has a $131 annual deductible, with 20% coinsurance after
deductible is met.
|
| Q. |
What is a Medicare Advantage Plan?
|
| A. |
Medicare Advantage is the name for a few different
type of plans that contract with the Federal Government.
Medicare Advantage offers a Medicare Managed Care Plan
(HMO), Medicare Preferred Provider Organization (PPO),
Medicare Private Fee-for-Service plan (PFFS) and
Medicare Specialty Plans. Essentially, these reduce
out-of-pocket expenses and increase coverage. These
plans provide all the benefits of Medicare Parts A and
B, plus additional benefits. The beneficiary continues
to pay the Medicare Part B premium as well as any
additional premium charged by the Medicare Advantage
plan. MedAdvantage is a PPO with a Medicare Advantage
contract.
|
| Q. |
Who is eligible? |
| A. |
Potential members need to be at least 65 years old
or disabled as defined by Medicare. They must have
Medicare Parts A and B, live within the service area,
and not have end-stage renal disease (ESRD).
|
| Q. |
Why should a consumer choose a MedAdvantage
plan as compared to an HMO product or a Medicare
Supplement product? |
| A. |
There are three types of health care plans that can
protect from unexpected costs. Health Maintenance
Organizations (HMOs) are managed care plans that require
the member to use only contracted doctors and hospitals
and typically referrals are required to see specialists.
Preferred Provider Organizations (PPOs) also have a
contracted network of providers, but the member can see
any provider who accepts Medicare patients and still
receive coverage. The member’s coverage is higher if the
member stays in-network and no referrals are required.
- HMOs and PPOs offer extra benefits compared to
Medicare such as physicals and vision. HMOs and PPOs
roll original Medicare benefits and supplemental
benefits into one plan.
Medicare Supplement plans are secondary policies to
Medicare. They do not have a network of providers and
usually cost more than HMOs and PPOs. Most Medicare
Supplement plans do not offer coverage for physicals and
vision.
- Medicare Supplement plans help reduce your
out-of-pocket medical expenses for unexpected
medical costs associated with Medicare deductibles
and coinsurance. This coverage can include the Part
A and Part B deductibles and coinsurance, the
skilled nursing facility coinsurance, as well as
other benefits.
- There are twelve standardized Medigap plans,
labeled “A” through “L” each with different sets of
benefits and premiums. Plan A has basic supplemental
benefits, Plan J the most comprehensive. All plans
include Basic benefits.
|
| Q. |
What is the difference between MedAdvantage
and a standard Medicare Supplement Plan ? |
| A. |
With a MedAdvantage plan members are free to see any
provider accepting Medicare patients. Our provider
networks offer many qualified providers to choose from.
A member may choose to see a provider not in our
network, and accept a lower benefit. Members are
encouraged to see in-network providers to receive the
best benefit from the plan and lower out-of-pocket
costs. A member can choose to see providers
out-of-network but this means the member will have
higher out-of-pocket expenses. The opportunity for
members to choose who provides their care is one of the
advantages of a MedAdvantage plan.
|
| Q. |
How does a consumer find in-network
providers? |
| A. |
Sales packets and member welcome packets will
include provider directories.
|
| Q. |
What is the dental coverage? |
| A. |
A member can go to his/her regular dentist and is
covered up to $500 annually for preventive dental
services such as cleanings, x-rays and exams. See the
Summary of Benefits for limitations.
|
| Q. |
What is the vision coverage? |
| A. |
Members are eligible for routine vision exams once
every two years. There is a $5 copay for utilizing
in-network benefits. Vision hardware is covered up to
$100 every two years.
|
| Q. |
What about hearing services? |
| A. |
For Medicare-covered hearing exams (diagnostic
hearing exams), there is a $5 copay.
|
| Q. |
Are prescription drugs covered? |
| A. |
Yes, if you choose MedAdvantage + Rx or MedAdvantage
+ Rx Enhanced . You pay a share of your prescription
medication costs (copays or coinsurance), and your plan
pays a share.
|
| Q. |
What if I don’t want prescription drug
coverage? |
| A. |
If you don’t want or need prescription drug
coverage, you can choose just the MedAdvantage plan.
Please note that if you were Medicare eligible, do not
have creditable prescription drug coverage and didn't
choose a Medicare Part D plan by May 15, 2006, there is
a 1% of premium penalty for every month you could have
enrolled but didn’t.
|
| Q. |
What other services does MedAdvantage
provide? |
| A. |
Access to discount programs such as vision care
services, hearing care services, discounts at fitness
clubs and discounts on prescription drugs.
|
| Q. |
Are members locked into a MedAdvantage plan
for a certain period of time? |
| A. |
Yes, most people will be required to stay with the
same plan for one year. For people currently on
Medicare, the Annual Election Period (AEP) is November
15 to December 31. During this time, enroll in a
MedAdvantage plan and your coverage will start January
1. If you are already on a Medicare Advantage PPO, HMO
or PFFS plan you can still switch to a MedAdvantage
plan, or cancel your plan, during this time. If you
are currently on a Medicare Advantage plan you also have
an Open Enrollment Period (OEP) from January 1 to March
31. During this time you can switch Medicare Advantage
plans or cancel your plan and go back to Original
Medicare Part A and B.
Once you enroll in our plan it is effective until
January 1 of the following year. Your next opportunity
to change or enroll comes on November 15 each year for a
January 1 effective date.
|
| Q. |
What help is available for people with
limited income ? |
| A. |
Individuals on limited income, applying for
prescription drug plans (such as MedAdvantage + Rx), may
qualify for reduced premiums and/or copayments. To find
out more about eligibility and to apply, call
1-801-446-7283 |
