Medicare Insurance Explained

8/6/2019 Medicare Insurance Explained

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MostMedicare.com

Answer Guide


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In this guide, youll nd:

Where to start

Medicare Made Clear an Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Understand Your Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

How it works

Medicare Part A How it works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Medicare Part B How it works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Medicare Part C: Medicare Advantage How it works . . . . . . . . . . . . . . . . . . . . . .7

Medicare Part D: Prescription Drugs How it works . . . . . . . . . . . . . . . . . . . . . . .8

Medicare Supplemental Insurance Plans (Medigap) How it works . . . . . . . . . . .9

Making plans

Make a Confdent Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Ten Things You Should Know About Medicare . . . . . . . . . . . . . . . . . . . . . . . . 11-12

Extra Help is Available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Resource Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Useful Symbols Throughout this answer guide, we have placed symbolsto help you fnd more inormation about a topic.

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Medicare can be confusing. How do you nd the best

options to t your needs? This guide has some answers

that may be helpful.


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Answer Guide

Want to know more?

This answer guide is designed to help you understand the basics of Medicare,

Parts A to D, and more. It also includes a summary of Medicare programs that

may be available to you.

If you want to learn more, thats easy. Just go to MostMedicare.comor

call 1 (866) 843-3608, TTY 711, 8 a.m. 8 p.m. local time, 7 days a week.

Were Here to Help

Medicare helps millions o Americans get the health care they need. Just as important,

it oers you a choice o how you want to receive your benefts.Choosing Medicare coverage can be difcult. Your choice is important to your healthand your budget. We want to help you make the best decision or you.


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MedicareMadeClear.com3

You probably know that Medicare is a ederal health insuranceprogram or people 65 and older and others with disabilities.

Medicare Parts A and B are considered Original Medicare.

Part A pays or hospital care and Part B pays or doctor visits.

Medicare doesnt cover everything.

Medicare helps you get the coverage you need, but you should expect to pay some o the costs. I youchoose Parts A and B, youll fnd gaps in the coverage. Many people enroll in another Medicare planto help pay or costs and benefts that arent covered.

Medicare Part C (Medicare Advantage plans) covers all the services that Parts A and B cover.It may also include prescription drugs; vision, hearing and dental; and preventive services.

Medicare Part D plans help with prescription drug costs.

Medigap (Medicare supplemental insurance) policies help cover costs that Parts A and B dont cover.

Its easy to know if youre eligible.

I youre turning 65, you can enroll in a Medicare plan. You can enroll three months beore the moyou turn 65, the month o your birthday and three months ater. I you wait to enroll in a plan, there is

a chance youll have ewer choices and may have to pay more.

Your plan choices dont have to be permanent.

I your health care needs change over time, so will the health plans you want to choose. Youre not lockedinto one plan permanently. Youll have an opportunity to change plans at least once a year.

When are you eligible?

You are eligible

for Medicare if:

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Youre 65 or older or have a qualied disability.

Youre a U.S. citizen or legal resident forat least ve consecutive years.

Medicare Made Clear an Overview
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Answer Guide

Your biggest decision and one that is a good idea to make frst is whether you want OriginalMedicare (Parts A and B) or a Medicare Advantage plan. They cover the same basic services, but

work very dierently. Your choice depends on your needs.

Once you make that decision, there are other choices. I you pick Original Medicare, youll need todecide whether to buy aMedicare prescription drug plan or a Medigap policy. I you choose Medicare Advantayoull also have to pick a specifc plan rom a specifc company.

Understand Your Options

Medicare (Parts A & B)

Is provided by the government and government

subcontractors. Medicare pays ees or your caredirectly to the doctors and hospitals you visit.Some people call this ee or service.

Medicare Advantage (Part C)

Is provided by private companies approved by

Medicare. Medicare pays a fxed ee to the planor your care. Ten the plan pays the doctorsand hospitals.

Part Ahelps with hospital costs. Part C

plans combine hospital costs,doctor and outpatient carein one plan.

Additional benetsare often included, such as visionand hearing services.

Part Bhelps with doctor and

outpatient care.

Medicare SupplementInsurance Plans

cover some costs not coveredin Parts A & B.

Part Dhelps pay for

prescription drugs.

Part Dis available in Medicare Advantagplans. Some plans offer built-indrug coverage. Other plans treat

as an optional add-on.

OR

Standard

Additional

Possible
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Medicare Part APart A helps with the cost o inpatient hospitalstays and skilled nursing ater a hospital stay.It also helps with hospice care or the terminallyill and some skilled care or the homebound.

What providers can I see?

You can choose any qualifed provider in the

United States that has been accepted byMedicare and who is accepting new patients.

Coverage limits.I youre hospitalized or in a skilled nursing acilityor a long time (more than 90 days at one time),there are limits.

What isnt covered.Doctor services in the hospital are covered byPart B, not Part A. And Part A wont pay orpersonal in-hospital costs, like a television ortelephone calls, or or custodial care helpwith eating, bathing or dressing.

Costs.Premiums. Part A has no out-o-pocket costs, i

you or your spouse have made payroll contributionsto Social Security or at least 10 years. I you havent,the premium in 2010 is $461 a month.

Your share of the costs.Deductible. You have to pay a deductible beorePart A starts paying a share o your costs. In2010, its $1,100 or each hospital stay, subjectto certain limits.

Copay.Ater staying a certain number o days,

you pay a copay. For 2010, it s $275 per day(days 61 through 90) and $550 per day (days 91through 150).

Coinsurance. You pay a small coinsurance orinpatient respite care or hospice patients.

When can I join? As soon as you becomeeligible or Medicare.

How do I sign up? I youre getting SocialSecurity, youre automatically enrolled. You canalso sign up at your local Social Security ofce.

Can they refuse to cover me or delaycoverage? Not i youre eligible or Medicare.You cant be reused Part A because o yourmedical history or a pre-existing illness.

How it works.

Enrollment


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Answer Guide


You can choose any qualifed provider who is

eligible to participate in Medicare and who isaccepting new patients.

Coverage limits.There are limits on a ew services, or example,the amount Part B will pay or occupationaltherapy, and screening are covered only orspecifc times.

What isnt covered.Part B covers eyes, teeth or hearing only in certainsituations. It usually doesnt cover care outside theUnited States or help with things like bathing orgetting dressed.

Costs.Premium. This depends on your yearly income.

It can be automatically deducted rom your SocialSecurity benefts. For 2010, premiums range rom$96.40 to $353.60 a month.

Your share of the costs.Deductible. Beore Part B starts paying a shareo your costs, you frst have to pay a deductible.In 2010, its $155 or the year.

Copay. In 2010, outpatient hospital services copaysrange rom a ew dollars up to $1,100.

Coinsurance. Ater you pay your deductible,Part B generally pays 80%.

Medicare Part BYou dont have to sign up or Part B, but mostpeople do. It helps with the cost o doctor visitsand other medical services, including outpatientcare at hospitals and clinics, laboratory tests,

some diagnostic screenings, and some skillednursing care.

When can I join? As soon as you becomeeligible or Medicare. You can also join later on,but only at certain times o the year.

How do I sign up? I youre gettingSocial Security, youll be automatically enrolled.Otherwise, you can sign up at your SocialSecurity ofce.

Can they refuse to cover me or delaycoverage? Not i youre eligible or Medicare.You cant be reused Part B because o yourmedical history or a pre-existing illness.

How it works.

Enrollment


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In some plans, you choose a primary care doctor

who manages the care you get rom specialistsand hospitals. In others, you can go to anyMedicare-eligible provider who accepts theplans terms, conditions and payment rates.

Medicare Advantage plans have appointed serviceareas and oer nationwide emergency coverage.

Coverage limits.

Plans vary. Check the limits and exclusions.

What isnt covered.Part C plans cover the same services as Parts Aand B, except hospice care.

Costs.

Youll continue to pay your Part B premium.

And in many cases Part C may have its ownpremium too. Premiums vary widely.

Your share of the costs. Some plans havedeductibles. Some dont. Many charge copaysor coinsurance. Look at the plan or details.

Out-of-pocket limits. Some plans limit theamount you have to spend.

Coverage gap. I you have prescription drugcoverage, theres a coverage gap when the plandoesnt help you.

Medicare Part C:

Medicare AdvantageMedicare Advantage plans are run by privatecompanies. They combine help with hospitalcosts, doctor visits, and other medical services in

one plan. You can also include prescription drugcoverage, oten with no added premium.

How it works.

When can I join? As soon as youre eligible orMedicare. You must also join Parts A and B.

How do I sign up? Each company handlesits enrollment process. These plans renewautomatically as long as you pay your premiums.

Can they refuse to cover me or delaycoverage? Not i you have joined Parts A and B,and they are accepting new members.

Can I change my coverage later? Yes, you havea chance to change your coverage each year.

Enrollment
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Answer Guide

What pharmacies can I use?

Some plans limit your choice by area. Some

oer nationwide coverage. Some also oer mailorder service.

Coverage limits.Terms vary widely. Plans oer various levels o costsharing until you spend a stated amount in a year.In 2010, its $4,550.

What isnt covered.You get help paying the cost o a drug only iits covered by the plan. Most plans also have acoverage gap or donut hole, during which youhave to pay all costs.

Costs.

While plans may cover some o the same drugs,

their monthly premiums may vary. In Octobereach year, they announce their premiums or thecoming year. You may pay a premium penaltyset by Medicare i you dont sign up or Part Dcoverage as soon as youre eligible.

Your share of the costs. Some plans havea deductible, some dont. Some charge a copay.Others charge a percentage o the cost. In thecoverage gap, youll pay the entire cost.

When can I join? As soon as youre eligibleor Medicare. Your coverage renews automaticallyyear to year.

How do I sign up? Each company handles this.But you can join online at medicare.govor bycontacting a plan provider.

Can they refuse to cover me or delaycoverage? I you are entitled to Part A or areenrolled in Part B, you cant be reused.

Can I change my coverage later? Yes, you havea chance to change your coverage each year.

Medicare Part D:

Prescription DrugsPart D plans help with the cost o prescription drugs.Theyre optional, and i you dont sign up when youbecome eligible, you may pay a higher premium. Some

Medicare Advantage plans include prescription drugcoverage. Part D is sold by private companies. Plansoer dierent costs and dierent drug lists. The ederalgovernment sets the guidelines.

Enrollment

How it works.
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Medicare Supplemental

Insurance Plans (Medigap)Private insurance companies oer this type o coverage to help pay some or all o thecosts that Medicare Parts A and B dont cover. There are ten standardized plans, labeled

A through N.

When can I join?You can buy a Medigappolicyany time after you reach 65 and join MedicarePart B.They cant consider your medical healthhistory in setting your premium i you sign upduring the 6 months ater you turn 65. Depending

on where you live, plans may be available to personson Medicare due to a disability.

How do I sign up? Each private company thatoers Medigap policies handles its own enrollment.To join, youll need to contact the company and askhow to join.

Can they refuse to cover me or delay

coverage? Once your open enrollment periodends (up to six months ater turning 65), insurers canreuse coverage, charge you a higher premium basedon your health, or make you wait to get coverage or

an illness you currently have. In limited situations,you have the right to buy a plan, regardless o yourhealth, ater your open enrollment period ends.

Can I change my coverage later? You can dropyour policy and apply or another one at any time.

How does renewal work? Medigap policiesmust be guaranteed renewable. That means thepolicy must be renewed automatically rom year toyear, so long as you pay the premium on time.

Coverage limits.Medigap policies provide 365 more days ohospital care during your lietime. They dont

oer more days in a skilled nursing acility.

When I wont get help.These policies help cover the costs not covered byParts A and B; or instance, deductibles, copaysor coinsurance. They dont cover long-term care;routine vision, dental, or hearing care; hearing aidsor eyeglasses; or private-duty nursing.

Costs.As a general rule, the more generous the coverage,the higher the premium. Premiums vary widely.

And they may rise over time.

Your share of the costs.Deductible. Some plans pay your MedicarePart B deductible and some companies oerhigh-deductible versions.

Copay. Some plans require Part B copays ordoctor visits and emergency room trips.

Coinsurance. Some plans use coinsurance to split

costs between you and the insurance company untilyou reach your out-o-pocket limit.

How it works.

Enrollment
http://www.mostmedicare.com/http://www.mostmedicare.com/


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Answer Guide 1

Its a good idea to research your options.To learn what plans and policies are available in your area, you

can visit medicare.govor contact your State Health InsuranceAssistance Program (SHIP).

Make a Condent Choice

Whats important to you?

Look for a plan thats the right t for you.Theres no one size fts all. There are lots o choices, or instance:

Do I want only Original Medicare (Parts A and B)?

How about Original Medicare with (or without) a stand-alone Prescription Drug plan (Part D)

or Medicare Advantage plan (Part C)?

I I get a Medicare Advantage plan, do I want it with or without prescription drugs?

Enroll as soon as you become eligible.

I you wait, you could end up paying more in premiums.

If you need it, you can get extra help.

There is extra fnancial help available to pay or Medicare or those with lower incomes (see page 13).

Are you in good health or do youhave chronic conditions?

Are you eligible or any healthcare coverage besides Medicare?Will you keep that coverage whenyou retire?

Which prescription drugs do youtake regularly? How much do

you spend?

How much did you spend on carelast year? Do you expect similarcosts this year?

How much do you traveland where?

What doctors do you see regularlyand or what kind o care? How

would you eel about seeinga new doctor?

How does health care ft into yourbudget? Will you need fnancialhelp to pay or Medicare premiums?


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There are two ways to get Medicare.

You can choose Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C).Once youve made that decision, there are other things to consider. You have your choice oplans as well as your choice o private insurance companies that oer them.

There is drug coverage available.Medicare now includes prescription drug coverage (Part D). This coverage is optional.You can get prescription drug coverage through a Medicare Advantage plan. Some o theminclude drug coverage. Or you can enroll in a stand-alone Part D prescription drug plan togo with your Original Medicare coverage.

This is important to know: I you dont sign up or Part D prescription drug coverage assoon as you become eligible or Medicare, you may pay a penalty on your premium unlessyou qualiy or an exception.

Youll pay a share of the cost.Medicare helps you get the health care you need when youre sick, but youll still beexpected to pay a share o the cost. Youve already contributed to Medicare by payingtaxes while you worked. Now that youre starting to use your Medicare benefts, youllpay a share o the costs o the care you receive.

Your share may be larger than you expect.

I you choose Medicare Parts A and B, youll fnd that there are some expenses Medicaredoesnt cover. I you are seriously ill, these gaps create big bills. Thats why many peoplewho choose Medicare Parts A and B also buy a Medicare supplemental insurance policy.Another alternative is to choose a Medicare Advantage plan that can also help you avoidthese gaps.

Ten Things You Should Know

About Medicare
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Answer Guide 1

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Where you live makes a difference.

Medicare Parts A and B are the same across the United States. But other parts oMedicare (Parts C and D) are oered by private companies and may be available inspecifc counties, states or regions and not in others. There are Part C or Part D plansthat oer nationwide coverage. Medicare supplement policies are oered by private

companies, oer nationwide coverage and are available by state.

Medicare doesnt cover all your expenses.

Youll fnd that each part o Medicare has things it doesnt cover.

Start by looking at what you have now.

Look at your current health coverage. For example, i you have group coverage romyour job, or retiree insurance rom a ormer employer, youll want to see how thiscoverage fts with Medicare.

You wont want to put this off.

Timing matters when youre choosing Medicare coverage. Your enrollment windowbegins just beore you turn 65 or when you become eligible or Medicare due todisability. I you wait to join, you may fnd youll pay more and have ewer choices.

Its smart to review your choices once a year.

Once you choose your Medicare coverage, youre not locked into that choice orever.Youll have the chance to change your choices at least once a year. Thats why it makessense to check your coverage every year to make sure it still fts your health needs.

Dont be afraid to ask for help.

Theres help available or everyone making Medicare choices. And theres extra helpwith the cost o Medicare or people with little income and ew assets.


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I you have a lower income and ewer assets, you may qualiy or help.Less than hal o those who would qualiy actually sign up. So dont

hesitate to apply.

Contact your local Social Security Administration ofce or your states MedicalAssistance or Medicaid ofce.

Medicaid helps pay costs not covered by Medicare. It may also include some added

benefts that Medicare doesnt cover.

Medicare Savings Program helps you pay your Parts A and B premiums,deductibles, and coinsurance.

Programs of All-Inclusive Care for the Elderly (PACE) combines medical, social,and long-term care services or rail, elderly people who live in the community, not anursing home. Its not available in some states.

Prescription drug premium assistance programs help pay some or all o apersons Medicare Part D premiums, deductibles, and copays or coinsurance.

Other programs may be available in your state.

Whos eligible?It depends on your income. Your incomeincludes money you get rom retirementbenefts or other money that you report ortax purposes. Also your assets; or example,property other than your house. The incomeeligibility average is close to $16,245 a yearor an individual or $21,855 or a couple.

Want to learn more?

Contact your local Social SecurityAdministration ofce or the state MedicalAssistance or Medicaid ofce.

Heres how to apply:

Extra Help is Available
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Answer Guide 1

Get answers

Go to www.MostMedicare.com

or call 1-(866) 843-3608

Resource Guide

Where to get more answers.

Medicare Helpline

For questions about Medicare and detailedinormation about plans and policies in your area,call: 1-800-MEDICARE (1-800-633-4227),TTY1-877-486-2048, 24 hours a day,7 days a week. Or go to: medicare.gov.

Medicare & You 2010The ofcial Medicare handbook or Medicareprograms is updated each year. You can downloada copy at the Medicare website or call theMedicare Helpline to request a copy. For onlinetools to fnd and compare drug plans, MedicareAdvantage plans and Medigap policies, go to:medicare.gov.

Social Security Administration

For help with questions about eligibility or andenrolling in Medicare or Social Security retirementbenefts and disability benefts, and or questionsabout your eligibility or help with the costo Medicare coverage, call: 1-800-772-1213,TTY1-800-325-0778.

Administration on Aging

For help in fnding local, state and communitybased organizations that serve older adults andtheir caregivers in your area, call: 1-800-677-1116.Or go to: eldercare.gov.

Your current health planYour health plans customer service centercan answer any questions you may have aboutyour current coverage; call the number on youridentifcation card.

AARPFor inormation about Medicare and otherprograms or seniors, go to: aarp.org. The AARPwebsite oers educational materials aboutMedicare in its health section. You can alsoorder publications online.

Your states resources.

Your states Medical Assistance orMedicaid ofce

To learn i you are eligible or help with the costso Medicare, call your states Medical Assistanceor Medicaid ofce. They can answer questionsabout programs like PACE (Programs oAll-Inclusive Care or the Elderly) and theMedicare Savings Program.

You can also call the Medicare Helpline and askor the number or your states Medical Assistanceor Medicaid ofce.

Your State Health InsuranceAssistance Program (SHIP)For help with questions about buying insurance,choosing a health plan, buying a stand-aloneprescription drug plan or Medigap policyandyour rights and protection under Medicare, callyour State Health Insurance Assistance Program.This program oers ree counseling or decisions

about Medicare coverage. In some states, thisprogram is called the Health Insurance Counselingand Advocacy Program (HICAP).

Your states hospice organizations

For inormation about hospice care programsin your area, call your states hospice careorganization. Call the Medicare Helpline toget the number.


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2010 MostMedicare, Inc.

The family of UnitedHealthcare Medicare Solutions plans are insured or covered by an afliate of

UnitedHealthcare Insurance Company, a Medicare Advantage Organization with a Medicare contract anda Medicare-approved Part D sponsor.

Questions?

1-866-843-36088 a.m. 8 p.m. local time, 7 days a week.

www.MostMedicare.com

Looking for more information?Download our comprehensive easy-to-use reference guide tounderstanding Medicare and its coverage options. Its helpfulfor anyone interested in Medicare. The guide covers topics onunderstanding Medicare Parts A, B, C, D and more. Its availableonline at www.MostMedicare.com .

Medicare Insurance Explained

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