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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
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Coinsurance
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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.
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Copayment
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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.
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Deductible
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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.
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Health Maintenance Organization (HMO)
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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.
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In-Network
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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.
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Medicare Advantage Plan
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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.
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Medicare Health Plan
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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.
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Medicare Prescription Drug Plan
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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.
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Medigap Policy
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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.
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Open Enrollment
Period (Medigap)
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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.
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Out-of-Network
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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.
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Out-of-Pocket Costs
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Health care costs that you must pay on your own because they are not
covered by Medicare or other insurance.
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Part A (Hospital Insurance)
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The part of Medicare that pays for inpatient hospital stays, care in a
skilled nursing facility, hospice care and some home health care.
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Part B (Medical Insurance)
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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.
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Preferred Provider Organization (PPO)
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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.
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For more information:
U.S. Department of Health Services:
http://www.medicare.gov/default.asp
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