YOUR GUIDE TO MEDICARE

Medicare can be confusing. But you’ve got this. And we’re here to help. Whether you’re new to Medicare or just want a refresher, use this guide to help you understand what’s best for you.

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Medicare at a Glance

	PART A + PART B Original Medicare	PART D Prescription Drug Plans	SUPPLEMENT Medicare Supplement Plans	PART C Medicare Advantage Plans
What’s Covered:	Federal program that generally covers 80% of the cost of medical expenses.	Can be added to Original Medicare to help pay for your drug coverage.	Most plans limit out-of-pocket costs for care and offer more coverage than Original Medicare	Combines Part A, Part B and usually Part D coverage. Often offers extra benefits as well.
Hospital Insurance (PART A)	✓		✓	✓
Medical Insurance (PART B)	✓		✓	✓
Prescription Drugs (PART D)		✓		✓
Limited annual Out-of-Pocket Expenses			✓	✓
Dental				✓
Vision				✓
Fitness Benefit				✓
Hearing Aid				✓

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Original Medicare

Parts A & B

When you turn 65, have a qualifying disability or end stage renal disease (ESRD), you’re eligible for PART A and PART B – that’s Original Medicare.

Out-of-Pockets Costs

There are some out-of-pocket costs you’ll pay with Parts A and B.

Out-of-pocket Costs

Deductibles and copays for hospital stays

Part B annual deductible

20% of the Medicare-approved amount for most care you get from doctors or other health care providers, outpatient therapy, Medicare Part B drugs and durable medical equipment.

Routine dental care

Routine vision care eyewear

Routine hearing exam and hearing aids

Eligibility

You can sign up during these 7 months.  If you plan to work past age 65, these times can differ for you:

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Coverage Options

When You Need More Coverage

You may want more than Original Medicare gives you. That’s where your plan options come in.

Medicare Supplement

Covering Medicare Gaps

Medicare Supplement plans help limit out-of-pocket costs and offer more coverage than Original Medicare.  Private insurance companies sell them.  Monthly premiums are usually based on age.

• You can go to any doctor or hospital that accepts Medicare
• Options with low – or no – copays or coinsurance for a visit to the doctor or a stay in the hospital.

You can sign up for a Medicare Supplement plan without answering health questions during your Medigap Open Enrollment Period.  This six-month period begins on the first day of the month in which you’re 65 or older AND enrolled in Part B.  If you sign up after this period, you might have to answer health questions.

Medicare Part D

Prescription Drug Coverage

Original Medicare (Part A or B) doesn’t cover most prescriptions.  You can get Medicare Part D plans from a private insurance company.

Part D plans add extra coverage.

PART B Coverage	PART D Additional Coverage
Injections you get in a doctor’s office	Prescription drugs
Certain oral anti-cancer drugs	Biological products
Immunosuppressant drugs	Vaccines licensed under Public Health Service Act
Under limited circumstances, certain drugs you get during hospital outpatient treatment	Medical supplies associated with insulin injections, including syringes, needles, alcohol swabs and gauze
Drugs used with some durable medical equipment (like a nebulizer or external infusion pump)	A copay of $35 or less for select insulin drugs through the Senior Savings Model with some plans
You pay 20% of the Medicare-approved amount for these covered drugs.  And the Part B deductible applies	You pay a copay or coinsurance for these covered drugs.  The amount you pay is based on the plan you choose

Information on Costs

These plans vary in costs from company to company and year-to-year.  You might encounter:

• Copays and coinsurance
• Monthly premiums
• Annual deductibles

Extra Help

You may be able to get Extra Help to pay for your prescription drug premiums and costs.  To see if you qualify, you can call your local Social Security office.

Late Enrollment Penalty

You may have to pay a late-enrollment penalty if you don’t join a Medicare Part D drug plan when you are first eligible for Medicare and go without credible prescription drug coverage for 63 continuous days or more.

Medicare Part C

Medicare Advantage Plans

Some plans combine medical, hospital, and may also include prescription drug coverage, with extra benefits.  That means you get all your Medicare benefits in a single, all-in-one plan.  Private insurance companies offer these plans.  You’ll still pay your Medicare Part B premium every month.

• Options with $0 monthly premium
• Out-of-pocket maximums
• Extra benefits like vision, dental and hearing

Signing Up

You can sign up for a Medicare Advantage plan when you sign up for Original Medicare and during other periods.

Initial Coverage Election Period (ICEP) A 7-month opportunity surrounding your initial Medicare eligibility.

Annual Enrollment Period (AEP) October 15 – December 7

Medicare Advantage Open Enrollment Period (MA OEP)* January 1 – March 31

Special Enrollment Period (SEP) Based on a qualifying event, such as loss of coverage, moving to a new area, etc.

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Supplement or All-in-One

A Closer Look

Everyone’s needs are different.  Let’s look at Medicare Supplement and Medicare Advantage plans side-by-side so you can see what might work best for you.

Medicare Supplement	Medicare Advantage
Age-based premiums	Flat premium, regardless of age
Deductibles, copayments and coinsurance	Deductibles, copayments and coinsurance
No Part D prescription drug coverage	May include Part D prescription drug coverage
Standardized benefits	Benefits vary
Accepted by any Medicare Provider	Uses a provider network
Can change at any time during the year	Limited enrollment periods
May have to answer health questions and may have a pre-existing waiting period	No Health questions and no pre-existing waiting period
	May require additional prior authorizations for services
	May offer additional services including personalized support
	May offer reminders to keep you on track to complete preventive services

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Making Your Decision

What’s Right for You

It’s important to pick coverage that works for you.  Here are important things to consider when researching your options: