FRUSTRATED WITH MEDICARE?

• United Healthcare

• Empire

• Aetna

• Humana

• EmblemHealth

• Wellcare

FINDING THE BEST MEDICARE PLAN

All US citizens are eligible for Medicare when they turn 65. While most seniors are automatically enrolled in Original Medicare, Steven can assist you in finding a plan that offers additional benefits beyond the hospital and basic medical care.

MEDICARE ADVANTAGE

You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.

If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.

These are the different types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) plans:
In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.

Preferred Provider Organization (PPO) plans:
In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.

Private Fee-for-Service (PFFS) plans:
PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other healthcare provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Special Needs Plans (SNPs):
SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

HMO Point-of-Service (HMO-POS) plans:
These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Who can join a Medicare Advantage Plan?
You must have Medicare Parts A and B and live in the plan’s service area to be eligible to join.

How much do Medicare Advantage Plans cost?
In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join.

What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.).
The best Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D).
In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage. Plan benefits can change from year to year. Make sure you understand how a plan works before you join.

MEDICARE SUPPLEMENT INSURANCE

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It is made up of two parts: Part A (for hospital expenses) and Part B (for medical and preventative services).

By itself, Medicare doesn't cover all of your medical expenses. In fact, Medicare is designed to cover only 80% of your medical costs. The remaining 20% is your financial responsibility. You're paying for out-of-pocket costs such as inpatient hospital stays, deductibles, co-payments, durable medical equipment and doctor services. These can easily add up to thousands of dollars out of your pocket. A Medicare Supplement Insurance plan may help protect your savings and peace of mind.

One of the benefits of pairing a Medicare supplement insurance plan with Medicare is the flexibility. You can use any doctor or hospital that accepts Medicare, and you are not limited by a network.

If you do choose a Medicare Supplement, it is important to add an additional Part D plan to cover your Prescriptions. Medicare Supplement insurance do not include Prescription Drug Coverage.

You are able to explore all of your options with various carriers. You do not have to have the same carrier for your Medicare Supplement and Prescription Drug Plan.

PRESCRIPTION DRUG PLANS (PART D)

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you're first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you'll likely pay a late enrollment penalty unless you have other creditable prescription drug coverage, or you get Extra Help.

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

2 Ways To Get Drug Coverage through Medicare:

Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

What the best Medicare Drug Plans cover:

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.

A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:

• Provide written notice to you at least 60 days prior to the date the change becomes effective.

• At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.