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Don’t forget to enroll in: Medicare Open Enrollment
(October 15-December 7, 2016)

 

7 Facts about Medicare Open Enrollment

 Do you or someone you know require assistance to apply for Medicare? Here are 7 helpful tips and facts about enrolling in Medicare.

1. What is Medicare?

  • Medicare is this countries federal health insurance program for people who are:
  • •65 or older
    •Certain younger people with disabilities
    •People with End-Stage Renal disease (Requires Dialysis or Kidney Transplant)

2. When is the Open Enrollment Period?

  • The Medicare Open Enrollment Period is from October 15th until December 7th. During this time you can either enroll or dis-enroll in Supplement or Advantage plans.
    *If you miss the deadline, you will have to wait until the next general enrollment period, which is (January 1- March 31). Coverage would begin July 1st, 2017.

3. How To Get Started:


4. What are The different parts of Medicare?

Medicare Part A (Hospital Insurance)

  • Covers:

    •Inpatient hospital stays
    •Care in a skilled nursing facility
    •Hospice Care
    •Some home health care

Medicare Part B (Medical Insurance)

  • Covers:
    •Certain Doctors’ services
    •Outpatient care
    •Medical supplies
    •Preventive services

Medicare Part C (Medicare Advantage Plans)

  • A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
  • Medicare Advantage Plans include;
     Health Maintenance Organizations
    Preferred Provider Organizations
    Private Fee-for-Service Plans
    Special Needs Plans
    Medicare Medical Savings Account Plans.
    • If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
    • Most Medicare Advantage Plans offer prescription drug coverage.i

Medicare Part D (Prescription Drug Coverage)

  • Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
  • These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.ii

5. How to Apply for Medicare?

Two options:

1. In person: Make an appointment with your local Social Security Office to meet with a S.S. representative.
•Call: 1-800-772-1213 (7am-7pm) (Monday-Friday)
•(TTY) 1-800-325-0778 * If you are deaf or are hard of hearing use this number.

2. Online Application:
• www.ssa.gov/medicareonly

Enrollment Process

  • Enrolling in Medicare is quick, easy and convenient. There is an online application, so there is no need to drive to a local Social Security office. There are no forms to sign or documentation required. Once application is submitted, Social Security will process, and contact you if they need more information.
  • Medicare is managed by the Centers for Medicare and Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare. iii

Who can apply for Medicare Online?

Use the Medicare online application if you:

  • Are at least 64 years and 9 months old;
  • Signing up for Medicare but do not currently have any coverage
  • Want to delay Social Security Benefits
  • Are not receiving Social Security retirement, disability or survivors benefits

When can you apply?

•You should sign up for Medicare three months before reaching the age of 65.

•Example:

•If your Birthday is in April.


6. Helpful Links


7. Q & A

Consumer Questions

Medicare Advantage Plans

Medicare Supplements

What does the plan cover?

Covers what most of Medicare does, plus additional benefits. *Many services require you to cost share increasing your out of pocket costs.

Medicare pays its portion of eligible expenses. Medical Supplies pays eligible expenses not paid for by Medicare.

Can I budget for my monthly health care expenses?

It’s tough. You typically pay when you go directly to the hospital or doctor. *There may be a monthly plan premium.

Yes. You have a monthly premium, with little to no out-of-pocket expenses, when medical care is needed.

Can my plan be canceled?

Yes. Contracts are reviews annually, between the government and Medicare Advantage Plan. Plan cannot be renewed. Members can terminate plan.

No. Only you can cancel your plan by not paying the premium.

May I choose my hospital and care providers?

Typically, you can choose from a network of providers, which does fluctuate.

Yes.

Is pre-certification or qualification required?

Yes. *Some penalties may apply if you don’t follow the rules.

No.

Can I use hospitals and doctors everywhere?

Possibly not. Check the plan for details and termination provisions if you move out of the coverage area.

Yes.

How are the plans funded?

Medicare pays the Medicare Advantage Plan at a fixed amount. This is based on the areas usual and customary charges for medical services. *Members may be required to pay Medicare Advantage Plan Premium.

Policyholder premiums.

Do I continue to pay my Medicare Part B premium?

Yes.

Yes.

How can there be little or no premium for Medicare Advantage plans?

There may be a small premium initially. *There are costs and they can go up annually.

Medicare reimbursements to the Medicare Advantage Plans may not keep pace with medical inflation. Plans premiums can increase. Which increases co-payments, and decreases benefits and dis-enrolling members every year.

No surprises. The benefit structure is locked in. You know what you are getting year to year. Medicare deductibles and co-payments increase, and so does the Med sup benefits.

* Benefits do not decrease if plan premiums increase.

What does it cost me?

•Medicare Part B monthly premium

•Monthly Medicare Advantage premium (possibly)

•Monthly Medicare Advantage premium for the extra benefits chosen

•Deductibles and co-payments

•Medicare Part B monthly Premium

•Monthly Premium

i "What's Medicare?" Medicare.gov: The Official U.S. Government Site for Medicare. N.p., n.d. Web. 02 Nov. 2016.

ii Ibid

iii ibid

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