Medicare choices

After you enroll in Original Medicare (Parts A and B), there are two ways to get additional coverage.

Step 1

Enroll in Original Medicare.

Original Medicare
Provided by the federal government
  • Part
    A

    Helps pay for hospital
    A stays and inpatient care
  • Part
    B

    Helps pay for doctor visits
    and outpatient care
MEDICARE HEALTH
INSURANCE
Name:
JOHN L SMFTH

Medical Number:
1EG4—TE5-MK72

Entitled to:

HOSPITAL (PART A)
MEDICAL (PART B)

Coverage starts:

03-01-2016
03-01-2016


Step 2

Decide if you need additional coverage. You have two ways to get it.

OPTION 1

OR

OPTION 2

OPTION 1


Medicare Advantage Plan

Which Combines:

  • Part A
    • - Hospitalization
  • Part B
    • - Doctor Visits
    • - Outpatient Facilities
    • - Durable Medical Equipment
      (walkers, wheelchairs, etc); plus additional benefits
  • Part C
    • - Medicare Advantage Plans
    • - Combines part A + part B with additional benefits
  • Part D
    • - Prescription Drug Plan
    • - Often, but not always included in your medicare advantage plans

 OR 

OPTION 2

Medicare Part A Plan
 
Part A
  • - Hospitalization
Medicare Part B Plan
 
Part B
  • - Doctor Visits
  • - Outpatient Facilities
  • - Durable Medical Equipment (walkers, wheelchairs, etc); plus additional benefits
Medicare supplement insurance
Offered by private companies
Helps pay some (or all) of the out-of-pocket costs that come with original Medicare (depending on which plan you choose)
Medicare Part D Plan
Offered by private companies
Part D
Helps pay for prescription drugs

Things to Consider Before You Enroll

What is your current Medicare status and eligibility?

Your current life situation, such as your age and employment status, will affect your Medicare needs and choices. Find which of the descriptions below best fits you:

  • 1 Currently enrolled in Medicare
    • Make sure to review your coverage and budget needs at least once every year.
    • Review the Medicare plan choices in your area.

  • 2 Eligible for Medicare and working
    • If you have employer—provided health insurance, consult with your benefits administrator to see how Medicare might work with your current coverage.
    • If you don’t have employer—provided insurance, review the Medicare plan choices in your area.

  • 3 Eligible for Medicare and not working

    • If you have benefits through your previous employer, check with them before making any changes.
    • Talk to your local sales agent or call UnitedHealthcare to determine when you Can enroll in a Medicare plan.
    • Review the Medicare plan choices in your area.

  • 4 Eligible for Medicare and retiring soon or losing coverage
    • If you will have retiree benefits through your employer, talk to your benefits administrator to understand how Medicare might work with your retiree benefits.
    • If you’re losing your employer—provided coverage or if retiree coverage isn’t available to you, review the Medicare plan Choices in your area.
    • If your family or dependents are currently on your employer or plan—sponsored coverage and not yet eligible for Medicare, advise them to consider COBRA or the individual plans in your area.

  • 5 Not eligible for Medicare and retiring soon or losing coverage
    • Explore COBRA. Under COBRA, workers at companies with 20 or more employees can keep their empioyer—sponsored coverage for at least 18 months after leaving their jobs. The employee must pay the full cost of the policy.
    • Review the individual plan Choices in your area.

10 important things to know about Medicare Advantage
  • 1 You must continue to pay your Medicare Part B premium.
    Medicare then gives your premium to your UnitedHealthcare Medicare Advantage plan to help pay for your additional coverage.

  • 2 Joining a Medicare Advantage plan may affect your current coverage.
    If you have existing coverage or employer—provided health insurance and plan to work past 65, Check to see how joining a Medicare Advantage plan could affect or cancel your current coverage.

  • 3 It’s best to use network providers.
    Use of network health care and pharmacy providers is typically required. Using providers outside of the network may cost you more‘ In an emergency, you can use any provider.

  • 4 You may qualify for financial assistance.
    Depending on your financial situation, you may qualify for help paying your plan premiums or Part D medications through a low income subsidy or Extra Help.

  • 5 If you enroll in Part D late, you may pay a penalty.
    This is an additional amount charged by Medicare that will be added to your Part D premium if you go without Part D coverage for longer than 63 days in a row after your Initial Enrollment Period. Medicare Advantage plans that include Part D coverage meet Medicare coverage requirements.

  • 6 A Medicare supplement insurance plan (Medigap policy) is not a Medicare Advantage plan.
    Medicare suppiement plans are health insurance policies and are secondary to Original Medicare. Medicare Advantage plans combine Original Medicare Parts A and B, and sometimes Part D, into a single plan.

  • 7 Keep your member ID card handy.
    Members must present their UnitedHealthcare member ID card, not their Original Medicare card, when receiving services.

  • 8 Medicare Advantage offers the same protections as Original Medicare.
    Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare.

  • 9 Medicare Advantage has you covered.
    Medicare Advantage plans must cover all the services that Original Medicare covers and may offer additional benefits. important: Hospice care is still covered under Original Medicare. You may also receive more benefits if you have TRICARE for Life or VA coverage.

  • 10 You have a built-in financial safety net.
    Your plan’s annual out—of-pocket maximum is your safety net that ensures you’ll never pay more than a certain amount out of pocket in a given plan year for covered medical services.

Definitions


  • HMOs
  • PPOs
  • Medicare Supplements
  • PDPs
Medicare Advantage & HMOs

HMOs (Health Maintenance Organizations) are Medicare Advantage plans provided by private health insurance carriers. There are variations of Medicare Advantage Plans that require you receive services from within their provider network. If you go outside that network, you pay for it 100% out of pocket.

PPO

PPOs (Preferred Provider Organization), a Medicare Advantage plan, allow you to go outside of network at additional cost to you.

Medicare Supplements ("Med Supps")

Med Sups (Medicare Supplements), aka MediGap insurance plans, will cover expenses that Original Medicare Part A and Part B do not. Providing Essential peace of mind with no network or boundry restrictions.

PDP (PRESCRIPTION DRUG PLANS)

A Prescription Drug (PDP) plan helps lower the costs of medications.
Each plan has:

  • - different formulary’s (drug lists)
  • - different coverage levels for brand name and generic prescription drugs
  • - tiered co-pays
Your dedicated insurance agent will find the right one to meet your needs.

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