Medicare / Medicare Advantage

What is Medicare?

Medicare is our federal health insurance program for Americans who are:

What are the parts of Medicare?

There are four main parts to Medicare:

Part A (Hospital Insurance) - Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B (Medical Insurance) - Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Part C (Medicare Advantage) - Part C covers both parts of A & B, usually D, as well as preventive services.
Medicare Part D (prescription drug coverage) – Part D helps to cover the cost of prescription drugs (including many recommended shots or vaccines).

How does Medicare work?

With Medicare, you have two options for coverage:

Original Medicare:

Original 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 Medicare for your healthcare and drug coverage. These plans are “bundled”, and usually include Part A, Part B, and Part D. Some plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

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.

When do I Enroll into a Medicare Plan?

There are three enrollment periods:

Initial Enrollment: When you first become eligible for Medicare (birthday month, or disability for 24 consecutive months).
Annual Enrollment Period: 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 for Medicare Advantage: During January 1st through March 31 of each year, if you’re enrolled in a Medicare Advantage Plan, you could change to a new Medicare Advantage Plan or change to Original Medicare, as well as enroll in a completely separate prescription drug coverage plan.

We’re Here to Help!

Medicare Advantage Plans

If you have Medicare Part A and Part B, you can join a Medicare Advantage Plan. These plans are 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.

What are the Types of Medicare Advantage Plans?

Health Maintenance Organization (HMO) - when you have an HMO, you must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except for Emergency Care, Out-of-area Urgent Care and Temporary out-of-area dialysis. 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) - when you have a PPO, 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 go to out-of-network providers for covered services, but pay more.
Special Needs Plans (SNP) - a SNP provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid. SNPs tailor their benefits, provider choices, and list of covered drugs (formularies) that best meet the specific needs of the groups they serve. SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. Those eligible for SNP plans are: those who have Medicare Parts A & B, live within the service area, and meet one of three eligibility requirements SNPs: 1) Dual Eligible SNP (D-SNP), 2) Chronic Condition SNP (C-SNP), or 3) Institutional SNP (I-SNP).