humana medicare ebooklet

7/31/2019 Humana Medicare eBooklet

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Medicare: What You Need to KnowChoose the plan thats right for you

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The more you know, .

Use this book to get the most from Medicare

Although Medicare has lots of details, it doesnthave to be complex. Thats where this guidecomes in.

you need to choose a Medicare plan withand other resources. Youll know what to expectand get a better idea about the Medicareplan you need Original Medicare, MedicareAdvantage, Prescription Drug Plan, orMedicare Supplement.

Keep this guide handy for when you havequestions about Medicare. Resources like thiscan help you make better choices for morepeace of mind.


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In this book:

Common questions about Medicare ...........2 What is Medicare?

What are the different parts of Medicareand what do they cover?

When am I eligible for Original Medicare?

What happens if I dont sign up for Part B or Part D

What are the enrollment periods forthe different Medicare plans?

When do you become eligible for Medicare?

Your Medicare options ..................................10 Its your choice

Things to consider

How Medicare Advantage works

Whats the advantage of Medicare Advantage versusOriginal Medicare?

Medicare Part D Prescription Drug Coverage Get to know the coverage gap

Special Needs Plans

More about Medicare Supplement insurance

...............................22

Glossary ...........................................................28


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Common questionsabout Medicare

What is Medicare?

Medicare is the largest health insurance program offeredby the United States government serving more than 45million people.

Medicare covers Americans 65 and older and others whoqualify because of a disability.

Medicare is divided into four parts: A, B, C, and D. Parts A andB are considered Original Medicare.

The Centers for Medicare & Medicaid Services (CMS) runsMedicare. CMS is part of the U.S. Department of Health andHuman Services (HHS).


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When am I eligible for Original Medicare?

At age 65, youre eligible for Parts A and B, even if you still workor you may be eligible for Medicare because your spouse is a

worked for 10 years and had Social Security taxes withheld.

You must sign up for and pay a monthly premium for Part B

If youre under 65 and have a disability, you may also qualify for

Medicare Parts A and B.Youve probably already paid for Part A through paycheckdeductions. Keep in mind, some people have to sign up for PartA and may have to pay a premium. Also, many people haveto sign up and pay a monthly premium for Part B. If you havehealth coverage through your employer you should check with

plan thats right for you.

What are the different parts of Medicareand what do they cover?

Heres a Quick View:

What

Whooffers it

What it is

MedicarePart A

hospitalinsurance

The federalgovernment

Part A helps cover your carewhen youre admitted to a

hospital or skilled nursingfacility. It also helps coverhospice care and homehealthcare.

MedicarePart Bmedicalinsurance

The federalgovernment

Part B helps cover doctorsvisits and outpatient care. Italso helps pay for servicesPart A doesnt cover like someoccupational and physicaltherapy services and somehome healthcare. Part Balso covers some preventiveservices.

MedicarePart CMedicareAdvantage(MA)

Healthinsurancecompanies

Part C covers everythingParts A & B cover. It oftenalso covers other services likewellness programs.

MedicarePart DMedicarePrescriptionDrug Plan

Insurancecompaniesand otherprivatecompanies

Part D is optional prescriptiondrug coverage for people withMedicare. You arent requiredto have Part D, but may paya late-enrollment penalty ifbecome eligible.


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What happens if I dont sign up for Part B or Part D when I

pay a penalty for Parts B or D. If you are still working, talk withIf you plan to work after age 65, that person can help youdecide whether to keep your current health plan or switch to aMedicare plan. Medicare Parts B and D are optional. However,waiting to sign up can affect your costs down the road, ifyour reason for delaying coverage does not meet the

No penalty:

delaying your enrollment

Penalty:

If you delay and arent

Part B If you have grouphealth insurance

You may have to pay

a higher monthly

premium for the life of

your Part B coverage

Part D If you have creditable

coverage forprescription drugs

If you qualify for a

Low-Income Subsidy

You may pay a late-

enrollment penaltyeach month as long

as you have Part D

coverage

1-800-MEDICARE (TTY: 1-877-486-2048).

If you plan to continue working,


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Every year after you

Pre-Enrollment Period

Oct. 1 Oct. 14

During this period, people with

products will be offered during

the Annual Election Period.

Annual Election Period (AEP)

Oct. 15 Dec. 7

From Oct. 15 to Dec. 7, you can

enroll in a Medicare Advantage

plan for the next calendar year.

Annual Disenrollment Period(ADP) Jan. 1 Feb. 14

During this time, people who

have a Medicare Advantage

plan can disenroll and return to

Original Medicare. These people

also can enroll in a stand-alone

prescription drug plan.

Feb. 15 Oct. 14

Generally, you only can make

changes if you qualify for a

special exception.

Special Election Period (SEP)

Based on certain conditions

Some exceptions include

moving from your plans

service area or having

Medicaid coverage.

If you qualify for a special

election, you can enroll in a

Medicare Advantage plan

even between Feb. 15

and Oct. 14

hat are the enrollment periods for the different

Medicare plans?

Initial Enrollment Period

(IEP)

you turn 65

you turn 65

If youre turning 65, you have

seven months to enroll in a

Medicare or prescription

drug plan.

Supplement insurance plan

Medicare Supplement Open

Enrollment Period

the month in which you turn

age 65 or older and are enrolled

in Medicare Part B.

Medicare Supplement Open

Enrollment Period lasts for

six months.

You can purchase a Medicare

Supplement plan anytime

during the year. The best time to

purchase a Medicare Supplementplan is during the Open

Enrollment period. Some states

have additional open enrollment

periods including those for people

under 65.

There are also several situations

that may guarantee a Medicare

Supplement plan is available

to you, if certain criteria are

met. During these periods, an

insurance company cant use

medical underwriting.

You can enroll in one of the following plans during these times:

Jan. Apr. June July Aug. Sept. Nov. Dec.Oct.

(ADP) (AEP)(SEP)

Pre-enrollment period


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Its your choice

Parts A and B Original Medicare cover much of the medicalcare you need, but not all of it. Also, you have to pay adeductible and coinsurance when you use Part A and Part Bbeyond those included in Original Medicare.

Your MedicareOptions

Most people get their Medicare coverage in one of thesetwo ways.

OR

Stand-aloneprescription drug planrom a private company

Medicare Supplementinsurance rom aprivate company

These plans often include:


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Make sure youre covered

Even if you dont spend a lot on prescription drugs now, youmay in the future. Thats when Medicare Part D, can help coverthe cost of prescription drugs.

No surprises

A Medicare Supplement plan may help cover some unexpectedhealthcare costs, like a long-term hospital stay. Youll pay anextra premium, but youll know youll have coverage in time ofneed.

Things to consider

As you think about what you want from Medicare, consider:

Cost how much will you pay for premiums, deductibles,coinsurance, and copayments?

and Part B? Does it include prescription drug coverage?

Doctor and hospital choice Do the doctors, hospitals,pharmacies, and other providers you use accept the plan?

Convenience Does the plan require you to complete claimforms or other paperwork? Are providers who accept the plannearby? Can you get prescription drugs through the mail?

These premiums are in addition to any Original Medicare-

applicable premiums such as those or Parts A and B.Most people with a Medicare Advantage plan pay the planpremium, i applicable, in addition to the Medicare Part Bpremium. Your costs will di er depending on the coverageyou c oose an serv ces you use.

Whether you stay with Original Medicare or select a MedicareAdvantage plan, youll have coverage or routine servicescovered by Original Medicare. Youll also have coverage orservices that Medicare considers medically necessary.


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Whats the advantage of Medicare Advantage versusOriginal Medicare?

Many people choose Medicare Advantage plans becausethese plans usually reduce out-of-pocket costs. Medicarecan reduce out-of-pocket costs. For example, some MedicareAdvantage plans include:

Fitness programs

Gym membership

Mail-order pharmacy

Health education programs

A nurse advice hot line

In addition, many Medicare Advantage plans have optionalyour insurance to meet your needs. For example, you could add

dental or vision coverage. Theres an added cost for optional

Types of Medicare Advantage plans include:

Health Maintenance Organization (HMO) a primary carephysician arranges your healthcare within the plans network

Preferred Provider Organization (PPO) choose any provider,but youll probably pay less for in-network services

Private-Fee-for-Service (PFFS) choose any provider, butyoull probably pay a higher premium

How Medicare Advantage works

Private insurers work with the federal government toadminister Medicare Advantage plans. If you choose aMedicare Advantage plan, Part C, you never lose yourMedicare coverage. In fact, you remain a member of theMedicare program and continue to pay Medicare-applicablepremiums. You simply choose to receive your inpatient andcompany and may pay an additional plan premium formanaged care and additional coverage.

Government

You must have both Medicare Parts A and B to join aMedicare Advantage plan.


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meet the minimum requirements listed below.

2013

Total Cost

Deductible $325 $325 in Rx cost

$325

Initial

Coverage

Limit

$2,970 25% of theext $2,645($661.25)in Rx cost

$661.25

Coverage Gap $3,763.75 47.5% of brand-nameand 79% ofgeneric drugsof the next$3,763.75

$3,763.75

Annual Out-

of-PocketAmount

$4,750*

Catastrophic

Coverage

Medicareand Plancover 95%

$2.65 forgeneric /preferred multi-source drug and$6.60 for allother drugs; OR5% coinsurance.Whichever isgreater

* Annual Out-of-Pocket Amount does not include

monthly premiums.

Medicare Part D Prescription Drug Coverage

You should consider prescription drug coverage because itsoften a vital part of a healthcare plan. Thats why the followingpages focus on Medicare Part D. Use the information to help youdecide if a prescription drug plan meets your needs.

Part D prescription drug coverage is only available from privatecompanies with a contract with Medicare.

You usually choose Part D in one of two ways:

Separate stand-alone insurance you buy in addition toOriginal Medicare or Medicare Supplement insurance.

As part of a Medicare Advantage plan.

If you enroll in a Medicare Advantage plan with prescriptiondrug coverage, you dont need to sign up for a stand-aloneprescription drug plan. If a Medicare Advantage plan you wantdoesnt include Part D, you may be able to choose a plan thatdoes.

The list of medicines a Medicare prescription drug plan coversis called a formulary. The formulary must include some of themost-prescribed medicines for people with Medicare. Eachcarefully to make sure it covers medicines you use regularly.

In some plans, after your total drug costs reach a certain limit,name for this period is called the coverage gap sometimescalled the donut hole. After satisfying the coverage gap, youreceive catastrophic coverage. Here you are responsible for asmall copayment, about 5 percent of the cost of the medicines,the plan and Medicare cover the balance.


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Special Needs Plans

In some areas, you may be able to get a Medicare Advantage

they serve.

To join a Medicare-approved HMO Special Needs Plan, you musthave Medicare Parts A and B. Also, one of the following mustapply to you:

assistance from the State premium, co-pays, anddeductibles may vary based on income.

Medicare Advantage Special Needs Plans include all Medicare

healthcare needs

and Medicaid

Get to know the coverage gap

Chances are, youve heard of the Medicare prescription drugcoverage gap. Its also called the donut hole. The coveragegap happens when you have to pay part of your drug costs.

Heres how it works:

1. Some plans pay part of your costs until the total drug costs

add up to $2,9702. Then you pay 100 percent until your out-of-pocket costs

reach $4,750

3. After that your plan begins paying again after your yearlyout-of-pocket costs reach $4,750

Its called the coverage gap because the plan provides nocoverage between the $2,970 and $4,750 amounts.

In 2013, youll pay no more than 47.5 percent on applicablebrand-name drugs. Generally, youll pay no more than 79percent for generic drugs until your yearly out-of-pocket costsreach $4,750.

Some Part D plans provide coverage when youre in the

coverage gap. So, if you use a lot of prescription medicines,youll probably want to think about such a plan.

Medicare Part D offers prescription drug coverage throughlist of medicines. Choose your plan carefully to make sure itcovers medicines you use regularly.

Extra help in the Coverage Gap

If you qualify for extra help, the amount you pay for generic andbrand name drugs does not change in the coverage gap.


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High-level overview of Medicare Supplement plans:

Each Medicare Supplement plan has a unique combination of athats right for you.

More about Medicare Supplement insurance

Medicare Supplement insurance plans sometimes calledMedigap plans are health insurance policies sold by privateinsurance companies. Theyre designed to help with some costsOriginal Medicare doesnt cover.

Medicare Supplement plans work only with Original Medicare.Original Medicare and your Medicare Supplement policy bothpay a share of the Medicare-approved amounts for your covered

healthcare costs.

In most states, an insurance company can offer as many as 11yearly premium to the private insurance company.

Skilled Nursing Facility

Part A Deductible

Part B Deductible

Part B Excess Charges

charges

Foreign Travel Emergency

Provide basic coverageand help with unexpectedexpenses or extendedhospital stays

More than basic coverage;

ideal for those who wantpredictable monthly

Provide most protectionagainst high out-of-pocketcosts expenses

Help manageyour expenses

Basic

Foreign Travel Emergency


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State Health Insurance Assistance Program

Every state has a State Health Insurance Assistance Program(SHIP). This program gives free insurance counseling to peoplewith Medicare.

claims, supplement policies, and long-term care insurance.Trained volunteers provide help for dealing with claims andunderstanding health insurance needs.

These volunteers dont provide legal advice. They also wont sell,or insurance company. They provide information and help soyou can make your own decisions.

If you want to know more about your states SHIP or you wantto contact a SHIP counselor in your area, visit www.shiptalk.org.


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Caregivers

Many people trust someone else to help make healthcaredecisions. For instance, a spouse, sibling, grown child, or closefriend may help you:

Insurers sometimes call this person a caregiver. To share yourpermission.

To give your permission, youll need to read and sign a consentform. This consent only allows insurers to share health planinformation with your caregiver. Its different from grantingmedical power of attorney, which allows someone to makedecisions about your care.

StaySmartStayHealthy.com

Stay Smart Stay Healthy is designed to deliver guidance, andto support awareness and understanding of the healthcareindustry. The goal is simple: to educate about the healthcaresystem by removing the usual hurdles and replacing them withan informative and engaging series of videos.

Examples of videos available related to Medicare are:

Visit StaySmartStayHealthy.com today

To decide which plan works best for you, think about yourhealthcare needs and whats important to you. It makessense to shop around for your Medicare plan, just as youwould for any major purchase. Doing so can help you getthe best value for your money.

Can I get help with my Medicare costs?

If you have limited income and resources, you may be able toget extra help paying for your Medicare health coverage, PartAdministration at 1-800-772-1213 (TTY: 1-800-325-0778).Hours are 7 a.m. to 7 p.m., Monday through Friday.

Medicare

Medicare has many resources to help you choose the Medicarecoverage thats right for you. One resource is the Medicare &You handbook, which gives you detailed information aboutMedicare. People with Medicare receive this booklet in the maileach fall. To get a copy, visit www.medicare.gov.

Medicare Supplement

For more information on Medicare Supplement plans, pleasesee the publication Choosing a Medigap Policy: A Guide to HealthInsurance for People with Medicare developed jointly by theCenters for Medicare & Medicaid Services and the NationalAssociation of Insurance Commissioners.


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Convenience Will you have to complete claim forms or otherpaperwork? Will you be able to get healthcare services closeto home? Answering these questions now could save youheadaches in the future.

Doctors and other healthcare providers Do the doctors,hospitals, and other providers you use accept the plan?Being familiar with the doctors, staff and places you use forhealthcare can make your health care experience better.

Special Needs Plan Do you have a chronic condition likediabetes that requires special providers, drugs, or otherservices? If so, you should see if a Special Needs Plan isavailable in your area.

A nurse hot line? Are you willing to pay extra for additionalcoverage?

Value-added services Does the plan include dental or visioncare discounts? Base your decision on whats important to you

Compare Need to know what plans are available to you?all this and more at www.medicare.gov.

What to do next

Before you make a decision about your Medicare coverage, thinkabout whats most important to you. Here are some points toconsider:

Cost How much will you pay out of your pocket forpremiums, deductibles, coinsurance, and copayments? Reviewyour budget to make sure you choose a plan you can afford.

Employer plans Your current or former employer may

sponsor a Medicare plan. If so, it could save you money. Checkyour needs.

Coveragethe plan thats right for you.

Prescription drug coverage What medicines do you take?Make a list so youll know what youll pay and if the plancovers the drugs you need.

Mail-order pharmacy Many plans offer mail-orderprescription drug services. This option can save you time andmoney especially if you dont have a pharmacy nearby.


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Glossary

Annual Election Period (AEP) From Oct. 15 through Dec.

7, people who are Medicare-eligible can enroll in, disenrollfrom, or change to the Medicare Advantage or MedicarePrescription Drug Plan of their choice for the following year.

Caregiver Someone who helps another person meet theneeds and perform the activities of daily living.

Centers for Medicare & Medicaid Services (CMS) Thefederal agency in charge of the Medicare and Medicaidprograms.

Coinsurance A percentage of the costs for medicalservices or prescriptions that you pay out-of-pocket.

Copayment

Coverage Gap In some plans, after your total drug costsyour drug costs until you reach a set amount. Many peoplecall this period the donut hole.

Creditable coverage Health coverage you had in thepast that gives you certain rights when you apply for newcoverage.

Deductible The amount you pay for medical services or

Formulary Also called a drug list, the formulary lists thedrugs your plan covers. Its often divided into sections ortiers based on the amount your plan will pay for thedrugs in that group.


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Out-of-pocket costs Anything you pay out of your pocketfor medical care, prescriptions, and other healthcareservices. These include coinsurance, copayments, anddeductibles.

Original Medicare Original Medicare is the traditionalfee-for-service program offered directly through the federalgovernment. If you have Original Medicare, the federalgovernment pays directly for your healthcare services. Youcan see any doctor who takes Medicare anywhere in the

country.

PPOtype of health plan gives you freedom to choose your owndoctors and hospitals. However, your out-of-pocket costsare usually lower if you choose healthcare providers in theplans network.

Premium What you pay Medicare or a health plan forhealthcare coverage.

Private-Fee-for-Service plan (PFFS) With this type ofproviders that accept the plans payment terms. Some PFFSplans have a network of providers; you can still see out-of-network providers that accept the plans payment terms,but you may pay more.

Special Needs Plan (SNP)of the groups they serve. People with chronic conditions like diabetes or heart conditions or are dually eligible forMedicare and Medicaid, often have this type of plan.

Glossary

HMOtype of plan requires you to choose a primary care physicianin the plans network to coordinate your care. Visits tospecialists may also require a referral from your selectedprimary care physician.

Initial Enrollment Period (IEP) You can sign up forduring your Initial Enrollment Period. For example, if youreeligible when you turn 65, you can sign up during the seven-

month period that begins three months before the monthyou turn 65, including the month you turn 65, and endsthree months after the month you turn 65.

Medically necessary supplies that are needed for the diagnosis or treatment ofyour medical condition. These services and supplies mustmeet the standards of good medical practice in the localarea and cant be mainly for the convenience of you or yourdoctor.

Medicare Advantage Medicare Advantage plans,sometimes called Part C, are offered by private companiesapproved by Medicare. These plans provide all of yourPart A (Hospital Insurance) and Part B (Medical Insurance)

coverage. Medicare Advantage plans often offer extracoverage like vision, hearing, dental, or health and wellnessprograms. Most include Medicare prescription drug coverage,also called Part D.

Medicare Supplement These plans can cover unexpectedhealthcare costs, like a long-term hospital stay. Youll pay anextra premium, but it will help cover you in times of need.You can purchase a Medicare Supplement plan anytime.

Network A network is made up of healthcare providersthat have agreed to provide care based on a plans termsand conditions. These providers include doctors, hospitals,and other healthcare professionals and facilities.


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Remember you can review your healthcarenee s an change your Me icare A vantageor Prescription Drug plan between Oct. 15and Dec. 7, 2012

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