Open Enrollment – Health Plan Changes or Prescription Drug Coverage)
November 15, 2007 – December 31, 2007

[ Click Here ] To schedule a phone appointment with an Insurance Plan Specialist

Choose a plan that meets your needs:

Original Medicare Plan

This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.

The Original Medicare Plan is a fee-for-service plan managed by the Federal Government. In general, with the Original Medicare Plan:

  • You use your red, white, and blue Medicare card when you get health care.
  • You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
  • You pay a set amount for your health care (a deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (your coinsurance or copayment) for covered services and supplies (unless you have a Medigap policy or other supplemental insurance that may pay for these costs.)
  • You may have a Medigap policy or other supplemental coverage that may pay deductibles, coinsurance, or other costs that aren’t covered by the Original Medicare Plan.

Medicare Health Plans (like HMOs and PPOs)

These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan, but it is important to check with the plan because the costs for services will vary.

Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare. With Medicare Advantage Plans:

  • Some of the plans require referrals to see specialists.
  • In many cases, the premiums or the costs of services (co-pays and deductibles ) can be lower than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
  • The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
  • They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
  • They generally offer extra benefits, and many include prescription drug coverage.
  • In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
  • Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
  • You don’t need to buy a Medigap policy.

Medicare Health Plans include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-for-Service (PFFS) Plans
  • Medicare Medical Savings Account (MSA) Plans
  • Medicare Special Needs Plans.

Medicare Prescription Drug Plans

These plans add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare. They add coverage to:

  • The Original Medicare Plan
  • Some Medicare Cost Plans
  • Some Medicare Private Fee-for-Service Plans, and
  • Medicare Medical Savings Plans.

With a Medicare Prescription Drug Plan:

  • Generally, you pay less for your prescriptions.
  • You will get a plan member card after you enroll. You use this card when you go to the pharmacy to get your prescriptions filled.
  • You will pay the copayment, coinsurance, and/or deductible, if any.

If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs.

If you want to compare Medicare Prescription Drug Plans, use the Medicare Prescription Drug Plan Finder.

Medigap (Medicare Supplement Insurance) Policies

These policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan, you could get a Medigap policy to help cover the extra health care costs.

Medigap policies are health insurance policies sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. In general, with a Medigap policy:

  • You get help paying for some of the health care costs that the Original Medicare Plan doesn’t cover.
  • You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
  • You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.

Glossary of Terms

Coinsurance

The amount you may be required to pay for services after you pay any plan deductibles. In the Original Medicare Plan, this is a percentage (like 20%) of the Medicare approved amount.
You have to pay this amount after you pay the deductible for Part A and/or Part B. In a Medicare Prescription Drug Plan or Medicare Health Plan, the coinsurance will vary depending on how much you have spent.

Copayment

In some Medicare health and prescription drug plans, the amount you pay for each medical service, like a doctor's visit, or prescription. A copayment is usually a set amount you pay. For example, this could be $10 or $20 for a doctor's visit or prescription. Copayments are also used for some hospital outpatient services in the Original Medicare Plan.

Deductible

The amount you must pay for health care or prescriptions, before Original Medicare, your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year.

Health Maintenance Organization (HMO)

A type of Medicare Health Plan that is available in most areas of the country. Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list except in an emergency. Your costs may be lower than in the Original Medicare Plan.

In-Network

Doctors, hospitals, pharmacies, and other healthcare providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. In some insurance plans, your care is only covered if you get it from in-network doctors, hospitals, pharmacies, and other healthcare providers.

Medicare Advantage Plan

Health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program.

With Medicare Advantage Plans:

  • You generally get all your Medicare-covered health care through that plan.
  • Coverage can include prescription drug coverage.
  • You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
  • You may have lower out-of-pocket costs than the Original Medicare Plan.
  • You may have to use the plan's doctors and hospitals to get services.

Medicare Health Plan

A plan offered by a private company that contracts with Medicare to provide you with your Medicare Part A and Part B benefits, and in most cases, Part D prescription drug benefits. Medicare Health Plans include Medicare Advantage Plans (including HMO, PPO, or Private Fee-for-Service Plans); Medicare Cost Plans; PACE plans; Special Needs Plans; and Demonstrations/Pilot Programs.

Medicare Prescription Drug Plan

A stand-alone drug plan, offered by insurers and other private companies to people with Medicare who receive benefits through the Original Medicare Plan; through a Medicare Private Fee-for-Service Plan that doesn't offer prescription drug coverage; or who have a Medicare Cost Plan, or Medicare Medical Savings Account Plan. Medicare Advantage Plans may also offer qualified prescription drug coverage that must follow the same rules as Medicare Prescription Drug Plan.

Medigap Policy

Medicare supplement insurance sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Except in Massachusetts, Minnesota, and Wisconsin, there are up to 12 standardized Medigap policies labeled Medigap Plan A through Plan L. Medigap policies only work with the Original Medicare Plan.

Open Enrollment Period (Medigap)

A one-time only six month period when you can buy any Medigap policy you want that is sold in your state. It starts in the first month that you are covered under Medicare Part B and you are age 65 or older (or under age 65 in some states). During this period, you can't be denied coverage or charged more due to past or present health problems.

Out-of-Network

Generally, an out-of-network benefit provides you with the option to access plan services outside of the plan's contracted network of providers. In some cases, your out-of-pocket costs may be higher for an out-of-network benefit.

Out-of-Pocket Costs

Health care costs that you must pay on your own because they are not covered by Medicare or other insurance.

Part A (Hospital Insurance)

The part of Medicare that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.

Part B (Medical Insurance)

Medicare medical insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that aren't covered by Part A.

Preferred Provider Organization (PPO)

A type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

For more information:
U.S. Department of Health Services: http://www.medicare.gov/default.asp