Medicare is federal health insurance offered primarily to people age 65 and older and disabled individuals under the age of 65. There are two major types of Medicare: Original Medicare and Medicare Advantage plans. Original Medicare doesn’t cover everything. Many people with Original Medicare often purchase a Medicare Supplement Insurance Policy and/or a Medicare Part D Plan to help cover those additional costs.
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance)
Medicare Advantage Plans replace Original Medicare (Parts A and B), and may add extra benefits
Medicare Supplement Insurance Policies cover the portions that Original Medicare (Parts A and B) does not cover
Medicare Part D Plans cover prescription drugs
WHAT IS MEDICARE?
In most cases, Medicare is the federal health insurance program for people who are 65 or older, certain disabled people under 65 years of age.
Part A – Hospital Insurance
You are automatically enrolled in Part A when you apply for Social Security benefits, usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility.
Part B – Medical Insurance
Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services. . Part B has a monthly premium that is deducted from your Social Security benefit check.
Part C – Medicare Advantage
A type of Medicare health plan offered by a private insurance company that contract with Medicare to provide you with all your Part A and B benefits. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage plans offer prescription drug coverage.
Part D – Prescription Coverage
Part D coverage is not automatic — it’s available through private insurance companies that have contracts with Medicare. You can get through a stand-alone Part D plan or through a Medicare Advantage plan.
HOW DO I QUALIFY FOR MEDICARE?
Since there are many different types of Medicare, qualifying for Medicare isn’t always a “one size fits all” process.
Automatic Enrollment For Older Americans
If you’re getting ready for Social Security retirement, have disability benefits or railroad retirement checks, you will be notified when you become eligible for Medicare and you will receive the necessary information in the mail.
If you are 65, have worked for at least 10 years in Medicare-covered employment and live in the United States, you’ll be automatically eligible for Part A (hospital coverage) and will need to enroll in Part B (medical coverage). Part B comes with a low cost monthly premium.
Once you’ve enrolled, you’ll receive your red, white and blue Medicare card to use for covering your hospital and medical expenses. You’ll start paying your monthly premium for Part B and you’ll pay a deductible when you use your hospital coverage. When you become eligible for Parts A and B, you can also research and find Part C (Medicare Advantage) and Part D (prescription) coverage from private insurers.
What If You’re Not Retiring?
When you turn 65 (unless you are disabled prior to that age), you are automatically entitled to Medicare Part A provided that you have met the requirements (e.g., you have worked for at least 10 years). At this time, you may also elect to enroll in Part B. If you are still employed and working at this age, you can choose to defer your Part B enrollment until such time that you do retire (or until such time that you no longer receive medical coverage from your employer). Until that time, you will want to make sure that the Social Security Administration (SSA) knows that you are employed and that you have coverage under your employer.
Other Enrollment Situations:
The Social Security administration also offers Medicare coverage in several special situations. You can apply for coverage under any of the following situations:
You are a disabled widow or widower between the ages of 50 and 65 and have been receiving another type of Social Security benefit besides disability.
You are disabled, under the age of 65 and work for the government.
You, your spouse or a dependent child has permanent kidney failure.
When in doubt, contact the Social Security administration, or contact a friendly representative here at Florida Health Care Plans to learn more about your eligibility
WHEN TO ENROLL IN A MEDICARE ADVANTAGE PLAN
How does it work?
To be eligible to enroll in one of FHCP’s Medicare Advantage plans, you must live in our service area, be entitled to Medicare Part A, and enrolled in Medicare Part B. If you currently pay a premium for Medicare Part A and Medicare Part B, you must continue paying your premium in order to keep your Medicare Part A and/or Medicare Part B. Medicare then pays us a specific dollar amount to manage your care.
When you enroll in a Medicare Advantage plan you will no longer use your Original Medicare card to receive services. Instead, you will utilize your Member ID card that you will receive at the time of enrollment. Your out-of-pockets costs (includes any applicable monthly plan premium and costs paid to receive services) under one of our plans will generally be lower than your expenses would be with Original Medicare.
When can you enroll?
Fall Open Enrollment (Annual Election Period)
Time to review health and drug coverage and make changes.
|Every year from October 15 to December 7
Initial Coverage Election Period (ICEP)
The period during which an individual newly eligible for MA may make an
initial election to enroll in an MA/MA-PD plan.
|Begins 3 months immediately before a beneficiaries first entitlement to
both Medicare Part A and Part B and ends on the later of:
- The last day of the month preceding entitlement to both Part A and part B; or
- The last day of the beneficiaries Part B initial enrollment period.
|First day of next month after plan receives your enrollment request
Annual Disenrollment Period (ADP)
The period during which a beneficiary can disenroll from an MA-PD / MA-Only
plan to go back on to Original Medicare and enroll in a Stand-Alone Part D Plan.
|Every year from January 1 to February 14
||First day of next month after plan receives your disenrollment request
Special Enrollment Periods for limited special exceptions, such as:
- You have a change in residence
- You have Medicaid
- You are eligible for Extra Help with Medicare prescriptions
- You live in an institution (such as a nursing home)
|Determined by exception.
||Generally, first day of next month after plan receives your enrollment request
MEDICARE ADVANTAGE VS. MEDIGAP MEDICARE ADVANTAGE
The terms “Medicare Advantage (Part C)” and “Medicare supplement plans” are often used interchangeably when discussing Medicare plan options, but they are actually quite different.
Medicare Advantage plans are convenient ways to receive your Medicare Part A and Part B coverage, all at a low cost. With a Medicare Advantage Plan, you receive your health insurance coverage through a private insurer approved by Medicare. In addition, depending on your plan details, you may also get additional coverage, such as vision, hearing, dental and healthy living programs (like exercise plans or alternative medicine).
Medicare Advantage allows you to shop for the benefits that most match your healthcare needs. You’ll have all of the hospital and doctor coverage of regular Medicare, but you’ll pay lower co-payments and deductibles for that care. The additional benefits in areas that Medicare does not cover make it a great choice for people who want options in their health care plan. You’ll have the flexibility of choosing a doctor from your plan’s network of providers.
Medicare supplement plans work a bit differently. Rather than bundle the coverage up into one neat package, Medicare supplement is intended to be an additional form of coverage to add on to Medicare Parts A and B. It’s often called “Medigap” coverage because it covers the gap between your health care needs and your Medicare coverage amounts.
A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that is designed to supplement Original Medicare. This means that it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (such as co-payments, coinsurance and deductibles).
Medigap plans don’t offer many choices and are standardized no matter what insurance company is offering them, however rates will vary from one company to the next. There are 10 levels of Medigap coverage that you can obtain called levels A through N (with N being the most comprehensive). Medigap plans will only cover the gaps left by Medicare and do not offer any additional coverage like dental, hearing, vision or healthy living programs.
While Medicare supplement plans can add value to your Medicare plan, you’ll get the most options with a Medicare Advantage plan. In order to purchase Medicare Advantage you must be entitled to Medicare Part A and enrolled in Medicare Part B.
HMO VS. MEDICARE ADVANTAGE PPO
Medicare Advantage is a specific type of Medicare also known as Medicare Part C. The Medicare Advantage plan offers individuals an alternative to Parts A and B. While Medicare Advantage is a Medicare approved program, this health insurance is delivered through private companies.
In order to obtain Medicare Advantage, you’ll need to be entitled to Medicare Part A and enrolled in Medicare Part B. You’ll continue to pay the part B premium and you’ll retain all of your full Medicare rights – but you’ll have additional benefits that aren’t part of your Medicare coverage. Many people opt for Medicare Advantage as it can provide stable costs for dental, vision and alternative care. Since Medicare Parts A and B don’t offer full coverage of all health care needs, getting additional coverage through a Medicare Advantage plan can be a smart move.
Medicare Advantage plans come in two major varieties – HMO plans and PPO plans.
HMO plans, or health maintenance organizations, allow you to choose from a network of contracted, reliable doctors who work exclusively with your health plan’s members. You’ll choose a primary care physician from the plan network and be referred to specialists within the plan network if you need additional care. In addition to health insurance coverage, Medicare Advantage HMO plans also include prescription drug coverage similar to Medicare Part D coverage. Many retirees and seniors seek out HMO coverage because of the cost savings. With a Medicare Advantage HMO plan, you’ll be able to have all of the coverage of Medicare Part A and Medicare Part B with your additional benefits for one low monthly premium.
Another option for Medicare Advantage health insurance coverage is a PPO plan. Preferred Provider Organizations offer care within a network of physicians and hospitals. You can see providers outside of the network of physicians and hospitals but you’ll be paying more out of pocket. For example, with a Medicare Advantage HMO plan, your coverage may lead to a lower out-of-pocket expense in comparison to the same care covered by a PPO and using an out-of-network provider. Monthly premiums can be higher for PPO plans as well, which can be a problem for Medicare patients on a fixed income.
VOLUNTARILY ENDING YOUR MEMBERSHIP
There are only certain times during the year when you may voluntarily end your membership in FHCP. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”), which occurs every year from October 15 through December 7. This is the time to
review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1.
If you want to end your membership in our plan during this time, this is what you need to do:
If you are planning on enrolling in a new Medicare Advantage plan: Simply join the new plan. You will be disenrolled from our plan when your new plan’s coverage begins on January 1.
If you are planning on switching to the Original Medicare Plan and joining a Medicare Prescription drug plan: Simply join the new Medicare Prescription drug plan. You will be disenrolled automatically from our plan when your new coverage begins on January 1.
If you are planning on switching to the Original Medicare Plan without a Medicare Prescription drug plan: Contact Member Services for information on how to request disenrollment. You may also call 1-800-MEDICARE (1-800-633-4227) to request disenrollment from our plan. TTY users should call 1-877-486-2048. Your enrollment in Original Medicare will be effective January 1.
INVOLUNTARILY ENDING YOUR MEMBERSHIP
If any of the following situations occur, we will end your membership in FHCP.
If you do not stay continuously enrolled in Medicare Part A and Part B.
If you move out of our service area.
If you are away from the service area for more than 6 months.
If you become incarcerated (go to prison).
If you are not a United States citizen or lawfully present in the United States.
If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.
At FHCP, we’re committed to providing high-quality care and exceptional Florida health insurance plans at affordable rates. Our optional benefits allow members a greater level of coverage for greater peace of mind. Since 1974, we’ve been serving the local community with outstanding health coverage and services in our all-in-one facilities throughout the state. Learn more about our comprehensive health insurance plans in Florida—contact us today to get started!