Medicare / Medicare Advantage
Medicare – What You Need to Know!
Medicare is America’s federal health insurance program for Americans who are:
- 65 or older
- People who are disabled for 24 consecutive months, and
- People with End-Stage Renal Disease
Medicare covers hospital stays and outpatient care which is similar to other insurance plans. HealthTexas has cared for and treated Medicare and Medicare Advantage patients for over thirty years!
What are the 4 parts of Medicare?
- Part A (Hospital Insurance) - covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance) - covers primary and specialty care, medical supplies, and many preventive services.
- Part C (Medicare Advantage) - covers both parts of A & B, some D, as well as preventive services.
- Medicare Part D (prescription drug coverage) – covers the cost of prescription drugs, including many recommended vaccines.
With Medicare, you have two options for coverage:
- Original Medicare: Original/Traditional Medicare pays for many healthcare services and supplies, but not all. Included is Part A (Hospital Insurance) and Part B (Medical Insurance). You pay for services as you receive them. If you want drug coverage, you can add a separate drug plan (Part D) for an additional cost.
- Medicare Advantage: Medicare Advantage offers an alternative to Original/Traditional Medicare for your healthcare and drug coverage. These plans are “bundled”, and usually include Part A, Part B, and Part D. Most plans offer extra benefits, like preventative services that Original/Traditional Medicare doesn’t cover — like vision, hearing, and dental services. HealthTexas is exclusive with UnitedHealthcare for both HMO and PPO Medicare Advantage plans.
What is a Medicare Supplement Plan?
Medicare Supplement Plans can help pay for some of the remaining healthcare costs, like copayments, coinsurance, and deductibles. These plans are an additional expense. HealthTexas accepts most Medicare Supplement Plans.
When do I Enroll into a Medicare Plan?
There are three enrollment periods:
- Initial Enrollment: When you first become eligible for Medicare by turning 65 (birthday month) or you have been disabled for 24 consecutive months.
- Annual Enrollment Period (AEP): From October 15 to December 7 of each year you can enroll, change, or drop a plan. The first day of your coverage will begin on January 1st of the following year.
- Open Enrollment Period (OEP): If you’re enrolled in a Medicare Advantage Plan, from January 1st through March 31 of each year, you can change to a new Medicare Advantage Plan, change back to Original Medicare and enroll in a completely separate prescription drug coverage plan.
Benefits At A Glance
Medicare Advantage Plans
Medicare Advantage Plans are for Americans who have Medicare Part A and Part B. These plans are approved by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include Part D, drug coverage.
Before joining a Medicare Advantage Plan, you should talk to your employer, union or other benefits specialist about their rules before you join a plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer/union coverage. If you drop or lose employer/union coverage for yourself, you might also lose coverage for your spouse or dependents.
Medicare Advantage Plans are for Americans who have Medicare Part A and Part B. These plans are approved by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include Part D, drug coverage.
Before joining a Medicare Advantage Plan, you should talk to your employer, union or other benefits specialist about their rules before you join a plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer/union coverage. If you drop or lose employer/union coverage for yourself, you might also lose coverage for your spouse or dependents.
There are three types Medicare Advantage Plans:
- Health Maintenance Organization (HMO) – with an HMO plan, you are required to receive care and services from doctors, other health care providers, and hospitals within the plan’s network. Treatment in Emergency Centers/Rooms, Out-of-Area Urgent Care and Out-of Area Temporary Dialysis Centers are the exception. It is very important that you follow the plan’s rules, like getting prior approval for a certain service when the plan requires it.
- Preferred Provider Organization (PPO) – with a PPO plan, you can get your care and services from the PPO network of doctors, other health care providers, and hospitals. You will pay less if you go to providers and facilities that belong to the plan’s network; however, you can generally see out-of-network providers for covered services but pay more.
- Special Needs Plans (SNP) – a SNP plan benefits and services are tailored to people with specific diseases and healthcare needs. SNPs are either HMO or PPO plan types; however, SNPs might also cover extra services. Those eligible for SNP plans are: those who have Medicare Parts A & B, live within the service area, and meet one of three eligibility SNP requirements: 1) Dual Eligible SNP (D-SNP), 2) Chronic Condition SNP (C-SNP), or 3) Institutional SNP (I-SNP).
