The parts of Medicare coverage

ORIGINAL MEDICARE

Part A

Hospital Insurance

• Inpatient care in hospitals

• Skilled nursing facility care

• Hospice care

• Home health care

Part B

Medical Insurance

• Inpatient care in hospitals

• Skilled nursing facility care

• Hospice care

• Home health care

COVERAGE OPTION 1

Medicare Supplement

(also called Medigap plans)

• Helps pay the cost not covered by Original Medicare

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Part D

Prescription Drug Coverage

• Covers mail-order or retail prescription drugs

COVERAGE OPTION 2

Part C

Medicare Advantage

• Covers Parts A & B services

• Provides fixed copays when you use doctors and hospitals

• Plans can include prescription drug coverage (Part D)

• Many plans offer value-added extras like dental and vision

• Provides maximum out-of-pocket protection

Your Coverage Options

Why you need additional coverage

You are still responsible for deductibles and co-insurance with traditional Medicare (Part A and B only). The co-insurance you are responsible for is 20% of the bill, and there is no out-of-pocket maximum for this co-insurance. That means there is no limit to the amount of co-insurance you could be required to pay and why you need to consider additional coverage.

Most prescription drugs are not covered under Medicare Parts A and B. You may want to purchase drug coverage through a separate Prescription Drug plan (Part D) or through a Medicare Advantage plan (Part C).

How To Enroll

When eligible for Medicare, you need to determine the next steps. Each individual situation may be different, and it's important to know what to do.

If you plan to retire at age 65 or are not working, and do not already receive Social Security benefits. You need to sign up for Medicare Part A and/or Part B. Contact the Social Security Office 3 months before your 65th birthday

• Phone: 1-800-772-1213, TTY: 1-800-325-0778

• Online:www.socialsecurity.gov

Already receiving Social Security retirement, disability, or Railroad Retirement Board benefits you will automatically get Medicare Parts A & B and should receive your Medicare card in the mail 3 months before your 65th birthday. Have Medicare prior to 65, due to disability or end stage renal disease can stay on or change your existing Medicare Advantage Plan or consider a Medicare Supplement Plan with a Part D plan. Are under 65 but just became eligible for Medicare should contact C & R Benefits Center for all of your options

Turning 65

If you are not automatically enrolled in Medicare, then you will need to sign up. This enrollment period is time-sensitive. You have an initial enrollment period to sign up for Part A and/or Part B. You may have to pay a late enrollment penalty if you do not sign up when you first become eligible.

Initial Enrollment Period

The Initial Enrollment Period is the seven month period that begins three months before you turn 65, includes the month of your 65th birthday, and ends with the three months after you turn 65. Even though you have several months, the best time to enroll is during the first three months of your eligibility to make sure you get coverage as soon as you are 65.

Working Past 65

If you and/or your spouse are 65 or older, currently covered by an employer-provided group health plan, and plan to continue working, you may have options. Contact your employer or union benefits administrator to find out how your coverage works with Medicare.

Can I stay on my current employer coverage?

• If the company has more than 20 employees, you can stay on your current coverage. However, we recommend you review your options to understand if adding Medicare may be beneficial to you.

  • You may also want to contact your employer or union benefits administrator to find out how your coverage works with Medicare. It may be to your advantage to enroll in Part A and to delay enrolling in Part B.

• If the company has less than 20 employees, Original Medicare will be primary and you will need to apply 3 months before your 65th birthday.

  • You may also want to contact your employer or union benefits administrator to find out how your coverage works with Medicare.

When you stop working

You may qualify for a Special Enrollment Period if you or your spouse worked past the age of 65 and were covered by group insurance when you initially became eligible. You can sign up for Medicare while you are still covered by your group plan or during the eight months after your employment ends.

Enrollment Periods

An opportunity to enroll after the initial enrollment period may exist if you have a change in circumstances. You may not have to pay a late enrollment penalty if you enroll during this time period.

Annual Enrollment Period: Oct. 15 - Dec. 7

• You can change from a Medicare Supplement Plan to a Medicare Advantage Plan (Part C)

• You can change from current Medicare Advantage Plan to a different Medicare Advantage Plan

• You can change Prescription Drug Plans (Part D)

• You can drop a Medicare Advantage Plan or a Part D Plan

Medicare Advantage Open Enrollment Period: Jan. 1 - Mar. 31

• You can change from a Medicare Advantage Plan to a different Medicare Advantage Plan

• You can change from Medicare Advantage Plan to Original Medicare and a Medicare Supplement and Prescription Drug Plan (you may have to go through underwriting to qualify for the Medicare Supplement)

Special Enrollment Periods include, but are not limited to:

• Loss of group (employer) coverage

• Move (changing homes, moving to a skilled nursing facility or rehab institution)

• Change in eligibility for Medicaid or Low-Income subsidy (Extra Help)

• Have a qualifying chronic condition (for example: diabetes or heart disease)

Anytime

You can change Medicare Supplement Plans (you may have to go through underwriting to qualify)

Original Medicare - Part A & B

Enrolling in Original Medicare when you become eligible is the first step in your Medicare choices.

Part A - Hospital Insurance

Part A includes coverage for inpatient hospital care, hospice care, and inpatient care in a skilled nursing facility (rehab). This typically has a $0 premium (if you qualify) and deductibles and copays may apply.

Part B - Medical Insurance

Part B covers medical care and services provided by doctors/other medical professionals, durable medical equipment, and outpatient visits. This typically includes a monthly premium, an annual deductible and 20% co-insurance with no out-of-pocket maximum.

Part B does NOT cover

• Dental care

• Dentures

• Routine eye care/vision

• Hearing exams and devices

• Long-term care

• Most prescription drugs

To help cover these costs, you will want to consider your other coverage options.

Medicare Supplement

If you choose Original Medicare, one coverage option to help cover out-of-pocket costs (like co-insurance and deductibles) for Medicare-covered services is a Medicare Supplement Plan.

How Medicare Supplement Works

When you have a Medicare Supplement Insurance policy (also known as Medigap), it helps fill the gaps that Original Medicare does not. There are a variety of plans offered, and each one has a different level of coverage. You will want to consider adding a separate standalone Prescription Drug Plan (Part D). You do not need and cannot use a Medicare Supplement policy if you choose a Medicare Advantage Plan.

Benefits of Medicare Supplements

• There are no network restrictions; any provider that accepts Medicare will accept a Medicare Supplement.

• Medicare Supplement Plans are guaranteed renewable. This means as long as you pay your premium, your coverage will stay in place (premiums are subject to increase).

Medicare Advantage - Part C

Medicare Advantage Plans include services covered by Part A, Part B, and usually Part D. They are offered by Medicare-approved private companies that must follow rules set by Medicare.

How Medicare Advantage Works

With a Medicare Advantage Plan, you will receive all Original Medicare (Parts A & B) covered services. Most Medicare Advantage plans include Part D drug coverage.

Benefits of Medicare Advantage

• "All in one" alternative to Original Medicare

• Predictable out-of-pocket costs with a low or zero monthly plan premium

• Annual limit on out-of-pocket costs for Medicare-covered services

• Most plans offer additional benefits such as dental, vision, hearing, and fitness

Prescription Drug Plans

Prescription Drug Plans (Part D) provide coverage to help reduce your costs for medications through the mail or from a retail pharmacy. These plans are offered by select private companies and there are two ways they can be purchased:

• One way is in combination with Original Medicare (Parts A & B) and a Medicare Supplement plan

• The other way is part of a Medicare Advantage Plan (Part C)

How Prescription Drug Plans Work

Prescription drug plans cover a variety of brand-name and generic prescription drugs. These plans have different premiums, deductibles, and copayments that you pay in addition to your Original Medicare premium and any other premiums depending on the plan that you may choose. Every plan also has its own list of covered prescription drugs called a formulary, which lists those drugs that are covered as well as its own network of participating pharmacies.