WHAT IS ORIGINAL MEDICARE?
Original Medicare is a fee-for service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare approved amount and you pay your share (coinsurance and deductibles).
WHAT DOES PART A COVER?
In general, Part A covers inpatient care in a hospital, skilled nursing facility care, nursing home care (inpatient care in a skilled nursing facility that is not custodial or long term care, hospice care, home health care.
WHAT DOES PART B COVER?
In general, Part B covers medical necessary services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. Part B also covers preventative services like health care to prevent illness (like the flu) or detect it an early stage when treatment is most
likely to work best.
WHAT IS AN ADVANTAGE PLAN?
Medicare Advantage Plans are a type of Medicare Health Plan offered by a private company that contracts with Medicare to provide all of you Part A and Part B benefits. Most Medicare Advantage Plans also cover prescription drug coverage. Many Medicare Advantage Plans offer additional benefits such as dental, vision, hearing, over-the-counter items/catalogs and fitness plans.
WHAT IS A SUPPLEMENT?
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare. A Supplement is sold by private companies. Original Medicare pays for about 80% of the cost for covered health care services and supplies. Medicare Supplements do not include Prescription Drug Coverage.
WHAT IS PART D COVERAGE?
Part D covers prescription drug coverage. Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover. This is called a plan formulary. Plans can place drugs into different “tiers” on their
formularies.
Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies.
WHAT IS LOW INCOME SUBSIDY / EXTRA HELP AND HOW DO I APPLY?
Low Income Subsidy, also known as Extra Help, assists beneficiaries who meet
certain income and resource criteria. These amounts change annually. Low
Income Subsidy (LIS) helps people with Medicare pay for prescription drugs and
lowers the costs of Medicare prescription drugs.
A beneficiary may apply via Social Security Administration at 1-800-772-1213 or
online at https://www.ssa.gov/benefits/medicare/prescriptionhelp/.
WHEN CAN I ENROLL IN MEDICARE?
Medicare Beneficiaries have three types of Enrollment Periods. They are IEP
(Initial Enrollment Period), AEP (Annual Enrollment Period) and SEP (Special
Enrollment Period).
During IEP, you will have three months before you turn 65 and three months after
you turn 65 during which you must enroll in a Medicare Health plan. You may elect to enroll in a Supplement, a Medicare Advantage Health Plan, a Prescription Drug Plan, a Supplement and a Prescription Drug Plan or a Medicare Advantage Health Plan which offers Prescription Drug Coverage. You may not, however, enroll into a Supplement and Medicare Advantage Health plan, or a Prescription Drug Plan and a Medicare Advantage Health Plan.
Every fall during AEP, the Annual Enrollment Period, which is from October 15th to
December 7th , you may make changes to your current health plan.
Some beneficiaries qualify for an SEP, a Special Enrollment Period. These include if you move into or out of a service area, if you gain or lose an income source, qualify for Medicaid, qualify for a State Prescription plan, can give you an SEP. Anyone who receives Low Income Subsidy (Extra Help) or is in a Medicare Savings Plan has a continuous enrollment period. Those with a continuous SEP can enroll or make changes once per quarter during the first three quarters.
WHEN WILL I RECEIVE MY MEDICARE CARD?
If you are automatically enrolled, you will receive your Medicare card in the mail
from Social Security about three months before you turn 65. If you self-enroll
through Social Security, you will get your card about three weeks after you have
completed your enrollment.
DOES MEDICARE COVER DENTAL, VISION, AND HEARING?
Original Medicare (Part A and Part B) does not cover dental, vision and/or
hearing. You may purchase a separate dental, vision and/or hearing plan or you
may elect to enroll into a Medicare Advantage health plan that includes dental,
vision and hearing.
WHAT ARE THE DIFFERENCES BETWEEN HMOs AND PPOs?
If you enroll in a Medicare Advantage Health plan, you will have four main options (HMO, HMO-POS, PPO and PFFS). A Health Maintenance Organization (HMO) requires you to select one primary physician. The only way for you to receive other care is if your primary physician recommends a different doctor. Usually, you must receive your medical services from within a specific network of physicians. In some cases, you may or may not require a referral. This is a plan specific option.
A Health Maintenance Organization, Point of Service (HMO POS) requires you to select a primary physician, but you have the option to visit separate specialists for an extra copay.
A Preferred Provider Organization (PPO) differs from an HMO in that you do not have to select just on primary physician. You may see doctors within and outside of the Provider’s Network. However, if you utilize services from within the Provider’s Network, they will typically cost less money.
A Private Fee for Service Plan (PFFS) is similar to a PPO in that you can select any doctor. However, PFFS plans are not common and therefore less doctors will accept your plan. There may be additional fees if you see a doctor who does not accept your plan. This is known as balance billing.
CAN I HAVE MEDICARE AND MEDICAID AT THE SAME TIME?
The simple answer is YES, you may have Medicare and Medicaid at the same time.
You may be able to save more money and get more benefits as a result of having
Medicare and Medicaid.
DO I NEED TO RENEW MY POLICY EVERY YEAR?
Medicare policies typically automatically renew every year, unless your Health Plan Provider terminates the contract for that specific plan. However, every year during AEP (October 15th to December 7th ) you have the opportunity to make any changes to your plan.
HOW CAN I GET A NEW MEDICARE CARD IF I HAVE LOST MINE?
You can either visit your local Social Security Office or go to the Social Security
Administration website which is www.ssa.gov. Make sure to keep your card in a safe and secure place.
Please Note: MAKE SURE YOU ARE IN THE SOCIAL SECURITY WEBSITE AND NOT AN ADVERTISEMENT.
CAN I ENROLL MY SPOUSE ONTO MY MEDCIARE PLAN?
No. Medicare plans are for individuals only. Your spouse will need to enroll in
their own individual Medicare plan once they become eligible to do so.
CAN I ENROLL IN MEDICARE IF I RETIRE EARLY?
Retirement does not make you eligible for Medicare. You are only eligible to enroll in Medicare due to age or disability.
The Senior Benefit Connection, Inc.
65 County Road 639
P.O. Box 705
Wantage, NJ 07461
Contact SBC
info@seniorbenefitconnection.com
1(844) 350-1551
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.