2015 MAP TO MEDICARE
H2461 101314 T01 CMS Accepted 10/21/2014
S5743 101414 K01 MN CMS Accepted 10/21/2014
MAP TO MEDICARE
What is Medicare? ... 1
Part A: Hospital coverage... 2
Part B: Medical coverage. ... 3
Part B: Preventive services... 4
Plans for more coverage ... 5
Medicare Cost plans Medicare Advantage plans (Part C) Medigap plans (Medicare supplement) Part D: Prescription drug plans Choosing the right plan for you ... 10
Enrollment... 11
How to enroll in Original Medicare Initial Enrollment Period General Enrollment Period Special Enrollment Periods Medicare Part B Medicare Advantage (Part C) and Part D Medicare Cost plans Medigap plans (Medicare supplement) When will my coverage begin? ... 13
Part A Part B Part C Part D Switching plans and disenrollment ... 14
Annual Election Period Medicare Advantage Disenrollment Period Your Map to Medicare ... 15
Frequently asked questions ... 17
Glossary of Medicare terms... 18
Resources ... 19
Baby boomers are turning 65 at the rate of 10,000 per day across the nation.
– Minnesota Department of Human Services,
Project 2030, 2014
WHAT IS MEDICARE?
Medicare is a government health insurance program offered to Americans age 65 or older and those with certain disabilities.
You may have heard about different parts of Medicare, such as Parts A, B, C and D. These options for Medicare coverage will be explained throughout this guide. You can choose Original Medicare only, or pair it with a
private health plan. You can also choose a private health plan that includes Medicare and additional features and benefits. Examples of these plans include Medigap (Medicare supplement), Medicare Cost, Medicare Advantage (Part C) and Part D Prescription Drug Plans (PDP).
Original Medicare and other Medicare plans can offer you the medical benefits and health and wellness resources you need to manage a healthy life. This guide will help you better navigate the many parts of Medicare and explain how they work, so you can make the coverage choice that best suits your health needs.
ORIGINAL MEDICARE
You are eligible for Medicare if you are a U.S. citizen or Original Medicare has two parts — Part A and have been a legal resident for five straight years and: Part B. The Centers for Medicare & Medicaid
Services (CMS) administer Part A and Part B.
➜
You are 65 years or older and eligible to receive
Social Security Medicare Part A helps pay for inpatient care in
➜
You already get retirement benefits from Social hospitals and skilled nursing facilities. It is offered at Security or the Railroad Retirement Board, or you no cost to nearly everyone eligible for Medicare.
are eligible for them and have not filed for them
Medicare Part B helps pay for doctor visits and
➜
You or your spouse had Medicare-covered services, some preventive screenings, lab tests, government employment durable medical equipment and outpatient hospital
➜
You are under age 65, are permanently disabled and care. Part B is available for a monthly payment, called have received Social Security disability payments for a premium, to most people eligible for Medicare.
at least two years
Many people are automatically enrolled in Part A and
➜
You require ongoing dialysis for end-stage renal Part B by the Social Security Administration when
disease (ESRD) or need a kidney transplant they turn 65.
PART A:
HOSPITAL COVERAGE
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, home health care and hospice care after you pay your deductible and coinsurance. Typically, there is no premium for Part A. If you or your spouse has 40 or more quarters of Medicare-covered employment, then your Part A premium was already paid by your payroll taxes while working.
HOSPITAL SERVICES
Covers semiprivate room, meals and eligible services for up to 90 days per benefit period.*
FOR EACH BENEFIT PERIOD IN 2015:
Days 1 – 60: Eligible care is covered in full after you pay the deductible of $1,260
Days 61 – 90: You pay $315 per day
Days 91 – 150: You pay $630 per lifetime reserve day You pay expenses not covered by Medicare
SKILLED NURSING FACILITY CARE †
Covers eligible services after a hospital stay of at least three covered days.
FOR EACH BENEFIT PERIOD IN 2015:
Days 1 – 20: Eligible care is covered in full Days 21 – 100: You pay $157.50 per day You pay expenses not covered by Medicare
HOME HEALTH CARE VISITS †
Unlimited visits for home health care are paid in full when ordered by a doctor.
HOSPICE CARE FOR THOSE WHO MEET SPECIFIC REQUIREMENTS †
Provides coverage for drugs to control symptoms and relieve pain as well as short-term respite care and home health services.
*A benefit period begins on the first day of a hospital stay and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row.
†
Care must be provided by a Medicare-certified program or facility.
PART B:
MEDICAL COVERAGE
Medicare Part B covers doctor visits and services, outpatient hospital care, durable medical equipment and some medical services and supplies not covered by Part A. Generally, there is a monthly premium for Part B that you pay to the federal government (this is usually deducted from your Social Security check).
DOCTORS’ SERVICES
➜
Hospital, clinic, office and home visits
➜
Surgery
➜
Osteopathy and radiology
DIAGNOSTIC TESTS
➜
X-rays
➜
Lab tests
MEDICAL SUPPLIES AND SERVICES
➜
Certain diabetes testing supplies
➜
Surgical dressings, splints, casts and prosthetic devices
➜
Oxygen, ventilator-assist devices and durable medical equipment used at home
➜
Portable X-ray services
➜
Radiation therapy
➜
Other procedures that are part of your treatment but not covered by Part A
OUTPATIENT SERVICES
➜
Rehabilitation
➜
Diagnostic and treatment services
➜
Some services performed at a Medicare-certified ambulatory surgical center
FOR PART B IN 2015:
You pay a monthly premium of $104.90 You pay a yearly deductible of $147
You pay 20 percent of Medicare-approved expenses for eligible services and supplies after you meet your yearly deductible (Medicare pays 80 percent)
The Part B premium is separate from any monthly premium or coinsurance/copayments you may pay for a private Medicare plan.
Keep the Part B premium in mind when deciding what type of Medicare plan you can afford that will also meet your health care needs.
The 2015 Part B premium will be higher if an individual’s income is more than $85,000 (or a married couple’s income is more than $170,000).
In Minnesota, 15 percent of the state’s population are Medicare beneficiaries.
Kaiser State Health Facts, 2013
PART B:
PREVENTIVE SERVICES
Original Medicare covers an annual wellness visit and provides many preventive services and screenings at no cost to you. Preventive services help you and your doctor monitor and manage your health on a regular basis. These services may also uncover a disease or condition in its early stage when more treatment options are available. Your doctor can speak with you about these services and when you might need them.
PREVENTIVE SERVICES:
➜
A “Welcome to Medicare” preventive visit within the first 12 months of your Part B coverage
• This is a comprehensive physical exam and an evaluation of your medical history. At the end of your exam, your doctor should provide you with a personalized prevention plan that you can discuss and revisit during your yearly wellness exams.
➜
A wellness visit once every 12 months (after your first 12 months of Part B coverage)
➜
Cancer screenings, such as mammograms, colorectal and prostate screenings, Pap tests and pelvic exams
➜
Cardiovascular screenings once every five years to check cholesterol and other blood fat levels
➜
Bone mass measurements
➜
Flu shots, pneumonia and hepatitis B vaccines
➜
Diabetes and HIV screenings
➜
Stop-smoking counseling
➜
Glaucoma tests
➜
Medical nutrition therapy for those with diabetes
or kidney disease, or if referred to the service
by a doctor
PLANS THAT PROVIDE MORE COVERAGE
Medicare Part A and Part B cover basic hospital and medical needs but will probably not cover all of the medical costs you have. Supplemental hearing screenings, vision exams and most outpatient prescription drugs are not covered. You must also pay deductibles and coinsurance when you receive eligible health care services.
ORIGINAL MEDICARE DOES NOT COVER:
➜
Charges for inpatient hospital and skilled nursing days beyond Medicare’s limits
➜
Certain preventive/routine care services, such as vision exams and hearing screenings
➜
Most care received outside of the United States
➜
Prescription drugs not covered by Part A or Part B Fortunately, you can enroll in one of several private health or prescription drug plan options to reduce your out-of-pocket costs and get additional services to help you lead a healthy life.
Additional Medicare plans include:
➜
Medicare Cost plans
➜
Medicare Advantage (MA) plans
➜
Medigap (Medicare supplement) plans
➜
Prescription Drug Plans (PDP)
MEDICARE COST PLANS
WHAT YOU SHOULD KNOW:
➜
Regulated by both federal and state governments
➜
Pay secondary to Original Medicare for Part A services
➜
Primary payer for most Part B services
➜
Continue to pay your Part B premium (and Part A if applicable, if not paid by Medicaid or another third party)
➜
Allow enrollment at any time of year if you meet eligibility requirements
➜
Benefits, premiums and cost-sharing may change from year to year
➜
May or may not include Part D prescription drug coverage
YOU ARE ELIGIBLE FOR A MEDICARE COST PLAN IF YOU:
➜
Are eligible for Medicare Part A (you do not need to be enrolled in Part A to qualify)
➜
Are enrolled in Part B
➜
Live in the plan’s service area
Note: If you have ESRD, you may not
be eligible
MEDICARE ADVANTAGE PLANS (PART C)
WHAT YOU SHOULD KNOW:
➜
Regulated by the federal government
➜
Replace your Original Medicare benefits as long as you remain enrolled in the plan
➜
Provide all of your Part A and Part B benefits, plus additional medical coverage, in the convenience of one plan
➜
Continue to pay your Part B premium (and Part A if applicable, if not paid by Medicaid or another third party)
➜
Benefits, premiums and cost-sharing may change from year to year
➜
You are generally “locked in” to the plan until the next annual election period unless special circumstances apply
➜
May or may not include Part D prescription drug coverage
TYPES OF MEDICARE ADVANTAGE PLANS:
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO) Medicare Advantage Prescription Drug plans (MA-PD)
Offers a network of doctors, hospitals and other providers. Some plans require that you choose a primary care provider and you may need a referral for services from other providers or to see providers not in the plan’s network. Point of service (POS) plans allow you to see any provider without referrals; you may pay more for services from providers outside the network.
Offers a network of doctors, hospitals and other providers. You may also use providers outside the network, although you may pay more for those services.
HMO or PPO plans that include Part D prescription drug coverage. If you enroll in this type of plan, you’ll get all of your hospital, medical and prescription drug benefits from one plan. If you join a Medicare Advantage plan that offers prescription drug coverage, you must get your drug coverage from that plan.
YOU ARE ELIGIBLE FOR A MEDICARE ADVANTAGE PLAN IF YOU:
➜
Are eligible for Medicare Part A (you do not need to be enrolled in Part A to qualify)
➜
Are enrolled in Part B
➜
Live in the plan’s service area
Note: If you have ESRD, you may not be eligible
MEDIGAP (MEDICARE SUPPLEMENT) PLANS
WHAT YOU SHOULD KNOW:
➜
Minnesota has different types of Medigap plans regulated by the state government such as:
• Basic
• Extended Basic
• Medicare Select
➜
Plan benefits will never change
➜
Premiums may change each year
➜
Original Medicare is the primary payer for services covered by Parts A and B
➜
Continue to pay your Part B premium (and Part A if applicable, if not paid by Medicaid or another third party).
➜
Medigap plans help pay for some of the health care costs or “gaps” that Part A and Part B don’t cover
➜
Each type of Medigap plan has a different set of benefits and premiums
➜
Some plans offer optional coverage for an additional premium
➜
You will need to purchase a separate stand-alone Part D plan if you want prescription drug coverage
YOU ARE ELIGIBLE FOR A MEDIGAP PLAN IF YOU:
➜
Are eligible for Medicare Part A and enrolled in Part B
➜
Live in the plan’s service area
If you apply for a Medigap plan more than six months
after the month in which your Medicare Part B
coverage begins, you will be required to submit a
health history with your application.
PRESCRIPTION DRUG PLANS (PART D)
Medicare works with health plans and other private companies to offer prescription drug coverage.
These Medicare-approved plans are called stand-alone Part D plans. Some companies also offer Part D as part of a Medicare Cost or Medicare Advantage plan.
WHAT YOU SHOULD KNOW:
➜
Regulated by the federal government
➜
Provide coverage for generic and brand-name drugs
➜
Benefits, premiums and cost-sharing may change from year to year
➜
Plans vary by types of drugs covered, how much you pay and the pharmacy network you can use
➜
Continue to pay your Part B premium (and Part A if applicable, if not paid by Medicaid or another third party)
➜
All plans must provide at least a standard Medicare-approved level of coverage
• The standard Part D prescription drug plan has four stages of coverage
• In each stage, you and the plan pay a different share of your prescription drug costs.
See page 9 for more information.
➜
You are generally “locked in” to the plan until the next annual election period unless special circumstances apply
You do not have to enroll in a Part D plan. However, if you don’t enroll and don’t already have drug coverage that is as good as the standard Part D drug plan, you may have to pay a higher monthly premium when you enroll later. The longer you wait to enroll, the greater the penalty.
You must pay this higher
premium as long as you
have Part D drug coverage.
HOW STANDARD PART D COVERAGE WORKS: 2015 DEDUCTIBLES AND COST SHARING
YOU PAY
DEDUCTIBLE STAGE
You pay the first $320 of your prescription drug costs.
This amount is your plan’s annual deductible. $320
INITIAL When you reach your deductible, your plan pays 75
COVERAGE STAGE
percent of your prescription drug costs. You pay the
remaining 25 percent. This is called “cost sharing.” 25%
COVERAGE GAP STAGE
Once you and your plan (together) have paid
$2,950 in total drug costs you pay 65 percent of the plan’s costs for all generic drugs and no more than 45% of the plan’s costs for brand-name drugs.
This coverage gap is sometimes called the “donut hole.” The coverage gap ends when your total yearly out-of-pocket costs reach $4,700. “Out-of- pocket costs” means the amount you have paid for covered drugs for the calendar year. This does not include the amount the plan has paid or the plan premium you pay.
The brand-name drug coverage in the gap is subject to agreements between CMS and drug manufacturers. Not all brand drugs may be
discounted. Over the next several years, Medicare beneficiaries will continue to receive increased discounts on brand-name drugs, eventually eliminating the coverage gap by 2020.
CATASTROPHIC When the coverage gap ends, for the remainder of
COVERAGE the year, you pay only a $2.65/$6.60 copay or five
STAGE percent of your drug costs, whichever is greater.
The plan pays the rest.
65%
of plan’s costs for generic drugs and no more than
45%
of the plan’s costs for brand- name drugs
$2.65 generics and
$6.60 brand or 5% of your drug costs
YOU ARE ELIGIBLE FOR A MEDICARE PRESCRIPTION DRUG PLAN IF YOU:
➜
Are eligible for Medicare Part A and/or enrolled in Medicare Part B
➜
Live in the plan’s service area
CHOOSING THE RIGHT PLAN FOR YOU
There is no one-size-fits-all plan. Take time to research the benefits and services provided by different health plans. Talk to your friends and relatives who have Medicare. Everyone has unique needs and considerations when it comes to health and choosing a health plan. Use your answers to the questions on this page as a starting point to find out what type of Medicare plan is best for you.
EVALUATE YOUR CURRENT HEALTH CARE NEEDS
➜
Do I use my current health plan often for
regular visits or checkups for an ongoing health condition, or only once in a while for things like the flu shot or my annual physical? If you have frequent visits, you may want a plan with low or no copays per visit.
➜
How often do I, or will I, need to see a specialist, such as a cardiologist or an orthopedist? Make sure your provider network includes specialists, preferably with no referral required.
➜
Do I have any major surgeries or procedures coming up? Calculate your hospital or outpatient costs.
➜
How many prescription drugs am I currently taking? Check the plan formulary to make sure your drugs are covered.
➜
Do I want my plan to help cover things like hearing aids and eyewear? Not all plans cover these expenses.
EVALUATE YOUR FINANCIAL SITUATION
➜
If I don’t qualify for medical assistance, how much can I realistically afford to pay for health care coverage? Tally up premiums, deductibles, coinsurance payments and copays for each plan you are considering. Check to see if the plan includes the protection of an annual out-of-pocket maximum limit.
➜
Does my current non-Medicare insurance from my union group or employer still cover the health and drug services I need for a reasonable price? Talk with your group benefits administrator.
EVALUATE YOUR CURRENT LIFESTYLE
➜
Do I want a plan that provides fitness
benefits like a fitness program or health club membership discount, weight coach or weight loss program? These features may be a benefit or a value-add to a plan.
➜
Do I want a program that offers health and wellness features like a 24-hour nurse line? Your health — day or night — is important.
➜
How often do I travel and for what period(s) of time? Some plans offer travel benefits so you get the same coverage anywhere in the United States.
➜
Do I need a health plan that will cover health- related costs while I’m out of the country?
Original Medicare does not cover medical expenses outside of the United States.
➜
Do I want a health plan I can keep if I decide to permanently move to another state? Many plans require that you live in the plan service area.
Most Medigap plans are portable and will move
with you.
ENROLLMENT
HOW TO ENROLL IN ORIGINAL MEDICARE
The Social Security Administration automatically enrolls most people in Original Medicare when they request Social Security benefits, usually at age 65.
You can enroll in Original Medicare up to three months before your 65th birthday. You don’t have to
be retired or collecting Social Security benefits to enroll. Just know that if you are not collecting
Social Security benefits, you will not be automatically enrolled in Medicare and will need to contact Social Security to do so.
If you or your spouse are still working and have health coverage through an employer or union you may want to consider postponing enrollment in Part B. This will allow you more flexibility in Medicare coverage at a later date and delay your Part B premium cost while you’re covered by your employer or union.
If you don’t enroll in Medicare Part B when you are eligible, you will pay a 10 percent premium penalty for each year you delay enrollment. (This does not apply if you qualify for a Special Enrollment Period or if you have coverage from your or your spouse’s current employer.) To find out more about how to enroll in Medicare, visit ssa.gov.
INITIAL ENROLLMENT PERIOD
The first time you are eligible to sign up for Medicare is called the Initial Enrollment Period (IEP). You are eligible to enroll in Medicare Part A, Medicare Part B, Medicare Advantage (Part C) or a Part D drug plan during this time:
3
months after
3
months before
65 th
birthday month
eligible to enroll
Your coverage will start no earlier than your birthday month. If your birthday falls on the first day of the month, your effective date may be the first day of the month prior to your birth month.
GENERAL ENROLLMENT PERIOD
If you miss signing up for Medicare Part A or Part B during your Initial Enrollment Period, you will have another chance to enroll.
For Medicare Part A and Part B, you are allowed to enroll between January 1 and March 31 of each year.
Your coverage will begin in July.
SPECIAL ENROLLMENT PERIODS
Medicare Part B
A Special Enrollment Period allows you to avoid the penalty for late enrollment. You may qualify for a Special Enrollment Period if:
➜
You delayed Part B because you or your spouse has medical coverage through a union or employer with more than 20 employees, or
➜
You cancelled Part B coverage because you went back to work and have group medical coverage The Special Enrollment Period lasts eight months. It
begins when your employer or union coverage ends or when your employment ends, whichever is first.
Contact Social Security four months before you retire or when your employer or union coverage ends. Request a form that your employer will complete to begin your Special Enrollment Period. Then send the form with your Part B enrollment form to Social Security.
If you are age 65 and continue your employer coverage through COBRA, you should enroll in
Medicare Part B. You will not get a Special Enrollment
Period when COBRA ends. You must sign up for
Part B during the first eight months of your COBRA
coverage to avoid the late enrollment penalty.
SPECIAL ENROLLMENT PERIODS (CONT.)
Medicare Advantage (Part C) and Part D If you are already enrolled in Medicare and want to enroll in a Medicare Advantage or Medicare Prescription Drug Plan, you can do so during the Annual Election Period from October 15 to December 7 each year.
There are circumstances that may allow you to enroll in a prescription drug plan or Medicare Advantage plan after an Initial or Annual Election Period has ended.
The time frame for a Special Enrollment Period can vary, but it typically begins on the first day of the month in which the qualifying event occurs and lasts for three months.
Some common reasons you might qualify for a Special Enrollment Period include:
You become eligible for financial help from Social Security or your state, or you lose eligibility for this help You move outside your plan’s service area
Your plan’s government contract ends, or the plan goes out of business You lose prescription drug coverage from an employer or union, or your drug coverage is no longer as good as the standard Part D benefit
MEDICARE COST PLANS
Most Medicare Cost health plans have open enrollment year-round. If you’re newly eligible for Medicare, you can enroll during the three months before your Part B becomes effective. You also may be able to enroll at other times of the year. If you are locked into a Medicare Advantage plan or a prescription drug plan, you cannot enroll in a Medicare Cost plan until you are allowed to disenroll from the Medicare Advantage plan.
MEDIGAP PLANS (MEDICARE SUPPLEMENT)
You have a six-month Open Enrollment Period to enroll in a Medigap plan. It begins on the first day of the month your Medicare Part B coverage begins. If you enroll during this period, you don’t need to provide your health history to your health plan. If you delay enrollment in a Medigap plan you may need to provide your health history and could be denied coverage. If you enroll in a Medigap plan, you should not enroll in a Medicare Advantage or Cost plan.
If you want to enroll in a Cost or
Medigap plan and a stand-alone
prescription drug plan, you must
enroll in each plan separately.
WHEN WILL MY
COVERAGE BEGIN?
MEDICARE PART A
Most people are automatically enrolled in Medicare Part A on the first day of the month they turn 65. If you don’t receive an enrollment notice from Social Security a few months before your 65th birthday, please call 1-800-772-1213, TTY users call 1-800-325-0778, 7 a.m. to 7 p.m., Monday through Friday.
If you are disabled, there is a 24-month waiting period for Medicare after you become disabled. During this time, you may qualify for Medical Assistance, COBRA coverage or services from state programs.
MEDICARE PART B
Your effective date will depend on the month you enrolled in Part B during your Initial Enrollment Period.
ENROLLED IN PART B: PART B COVERAGE WILL START:
During the three months before you turn 65 Day one of the month you turn 65
During the month you turn 65 Day one of the month after your birthday month During the month after you turn 65 Three months after your birthday month
During the second month after you turn 65 Five months after your birthday month During the third month after your birthday month Six months after your birthday month
MEDICARE COST, MEDICARE ADVANTAGE (PART C) AND PRESCRIPTION DRUG (PART D) PLANS
Your effective date will depend on the month you enrolled during your Initial Enrollment Period.
ENROLLED IN MEDICARE COST, MEDICARE ADVANTAGE OR PART D:
PLAN COVERAGE WILL START:
During the three months before you turn 65 Day one of your birthday month
During the month you turn 65 Day one of the month after your birthday
During the three months after the month Day one of the month following your enrollment you turn 65
MEDIGAP (MEDICARE SUPPLEMENT) PLANS
Your effective date will depend on the month you enrolled during your Initial Enrollment Period.
ENROLLED IN MEDIGAP (MEDICARE SUPPLEMENT):
PLAN COVERAGE WILL START:
During the month you turn 65 Day one of your birthday month
During the six months after you turn 65 Day one of the month following your enrollment
SWITCHING PLANS AND DISENROLLMENT
ANNUAL ELECTION PERIOD
Medicare Advantage and Part D
During the Annual Election Period from October 15 to December 7, you can enroll in or change stand-alone prescription drug plans and Medicare Advantage plans with and without prescription drug coverage. Your coverage will start January 1 of the following year.
MEDICARE ADVANTAGE DISENROLLMENT PERIOD
The Medicare Advantage Disenrollment Period runs from
January 1 through February 14. During this time you
can disenroll from a Medicare Advantage plan (with or
without drug coverage) and return to Original Medicare.
YOUR MAP TO MEDICARE
Researching and preparing for enrollment in
Original Medicare and a Medicare health plan offered by a private company should be stress-free. The interactive guide on these pages can help you through your Medicare pre-enrollment journey. By filling in the answers and checklist, you can rest easy knowing you’ve completed the basic steps necessary to prepare for Medicare enrollment.
When is your 65th birthday? / / Most people start exploring their Medicare options about six months before they turn 65.
The month When to start you were exploring
born Medicare options
January July February August
The year
March September before
April October your 65th
May November birthday
June December
July January August February
The year
September March of your
October April 65th
November May birthday
December June
ARE YOU PLANNING TO RETIRE AT AGE 65?
Yes No
If you are planning to work after age 65, consider the following:
Research if Original Medicare or a Medicare plan offered by a private health care company offers additional benefits not covered by your employer or union.
Consider postponing your Part B enrollment and keeping your current employer or union benefits.
Talk with your plan administrator before you
disenroll from your current employer or union plan.
HAVE YOU SIGNED UP FOR ORIGINAL MEDICARE (PARTS A AND/OR B)?
Yes No
Contact the Social Security Administration about three months before you turn 65 to sign up for Medicare Part A and/or Part B.
If you currently receive Social Security retirement, disability benefits or railroad retirement checks, you should be automatically enrolled in Medicare.
For more information visit ssa.gov.
DO YOU QUALIFY FOR MEDICAL ASSISTANCE?
Yes No
If you have limited income and resources, you may be able to get extra help to pay for your Medicare plan premium and costs. Information about Medical Assistance can be found at medicare.gov.
ARE YOU PLANNING TO ENROLL IN A
MEDICARE HEALTH OR PRESCRIPTION DRUG PLAN FROM A PRIVATE COMPANY?
Yes No
Refer to the eligibility requirements to make
sure you can enroll in the plan of your choice.
HAVE YOU RESEARCHED VARIOUS MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS IN YOUR AREA?
Yes No
Visit bluecrossmn.com/medicare to view plans offered by Blue Cross and Blue Shield of Minnesota.
Call and speak with a Medicare consultant.
See resources on page 19.
ARE YOU PLANNING TO ATTEND A COMMUNITY MEETING?
Yes No
Community meetings are presentations given by licensed Medicare consultants who explain Original Medicare and Medicare plan benefits and features.
For a list of community meetings in your area, visit bluecrossmn.com/medicaremeetings or call the phone number listed on page 19.
List meeting(s) you plan to attend:
Date: Place: Time:
Date: Place: Time:
Date: Place: Time:
HAVE YOU CHOSEN A LICENSED AGENT OR MEDICARE CONSULTANT TO ASSIST YOU WITH YOUR MEDICARE ENROLLMENT AND PLAN?
Yes No
Many people find an agent helpful during the
enrollment process. Agents can answer any questions or concerns and offer guidance in later years in the event you want to switch your Medicare plan.
Visit bluecrossmn.com and select “Find an agent”
for a list of Blue Cross agents in your area.
Make sure to ask if he or she is certified to sell Medicare.
You do not need an agent or Blue Cross consultant to enroll. Many plans allow you to enroll online, by telephone or with a paper enrollment form.
USE THIS AREA TO WRITE NOTES, PLANS OF INTEREST AND RESEARCH FINDINGS
If you have chosen an agent, feel free to insert your agent’s contact information:
Agent name:
Company or agency:
Phone number:
Email:
FREQUENTLY
ASKED QUESTIONS
Q. Are there options if I can’t afford Medicare?
A: Your health is very important, and help for your health care needs is available. If you have limited income and resources, you may be able to get extra help to pay for your Medicare health and prescription drug plan premium and costs. To learn if you qualify for extra help, call:
• 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048 24 hours a day, 7 days a week
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
• Or your state Medicaid office
Q. How do I keep up with changes to Medicare?
A: For information about Medicare benefits and services call the Medicare number listed above or visit medicare.gov.
Q: Do I need a physical exam to qualify for Medicare?
A: No. You must be 65 or older, be under age 65 with a disability, or meet other requirements as explained in this booklet.
NOTES:
Q. Do Medicare premiums, deductibles and cost sharing change? How will I learn about changes?
A: Medicare premiums, deductibles and cost sharing may change. Changes are announced each fall for the coming year. Medicare beneficiaries are notified by mail.
Q: Can I use my existing health savings account (HSA) dollars for Medicare coverage or services?
A: When you turn 65 or enroll in Medicare, your HSA money will still be available to use for qualified medical expenses with no federal tax or state tax (in most cases). You cannot continue to contribute money into this account, but you can spend any remaining funds.
You may use HSA dollars to pay premiums for Part A, Part B, Part C and Part D coverage.*
*Contact your HSA plan administrator for more
information about eligible medical expenses.
GLOSSARY OF
MEDICARE TERMS
Benefit period — Begins on the first day of a hospital stay and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row.
The Centers for Medicare & Medicaid Services (CMS) — The federal agency that runs Medicare.
CMS also works with each state to run its Medicaid program. CMS makes sure that people in both programs have access to high-quality health care.
Coinsurance — The percentage of the approved amount that you pay for a medical service. With some plans, you do not pay coinsurance until you have paid a deductible.
Copayment (copay) — A fixed amount you pay for each medical service, such as a doctor’s visit.
Cost sharing — The way Medicare and your health plan share your health care costs with you. Types of cost sharing include deductibles, coinsurance (percentage) and copayments (a set amount).
Deductible — A set amount of money you must pay before your plan pays. Usually you have a separate deductible for Medicare Part A, Part B and Part D.
Deductibles may also come with Medicare health plans.
Eligible care — Medical care and services that qualify to be covered by Medicare and/or your health plan.
In network — When you receive services from a participating provider or pharmacy in the plan’s network. These services are provided as part of a contract with the provider or pharmacy to offer lower costs to members of plans.
Lifetime reserve days — Extra days that Medicare will pay for when you are in a hospital for more than 90 days. You have 60 lifetime reserve days to use during your lifetime. With Original Medicare, you have a per-day copay when you use lifetime reserve days.
Out of network — When you receive services from a provider or pharmacy that is not participating in the plan’s network. You usually pay more for these services since they are not provided at the lower in-network rate.
Out-of-pocket maximum — The total amount you pay for medical services or prescription drugs each year (including copayments and coinsurance) before the plan pays 100 percent of remaining eligible charges.
Premium — A fixed payment, usually paid each month, for Medicare Part B (paid to the federal government) and for a Medicare health plan and/or prescription drug plan (paid to a private health plan).
Preventive care — Care that is provided to keep you
healthy or find an illness or disease early, when it can
be better treated. Examples of preventive care are flu
shots, cancer screenings and screening for diabetes.
RESOURCES
COMMUNITY MEETINGS
If you will soon be eligible for Medicare, you should begin evaluating your options for health and prescription drug coverage. You may want to consider attending a community meeting in your area where a licensed Medicare consultant will explain Medicare and the plans offered by Blue Cross and Blue Shield of Minnesota. Every year in Minnesota, thousands of people just like you attend these meetings to find out more about their Medicare options.
For a list of community meetings in your area visit:
bluecrossmn.com/medicaremeetings Plans are available to residents of the service area. Medicare Cost, Medicare Supplement and Prescription Drug Plans will be discussed at the meetings. A sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call 1-800-711-9874, TTY users call 711, 8 a.m. to 8 p.m., Central Time, daily.
Blue Cross offers Cost and PDP health plans with Medicare contracts. Enrollment in these plans depends on contract renewal.
LEARN MORE
For information about our plans, contact your local agent or call Blue Cross directly.
Blue Cross 1-877-662-2583 TTY users call 711
8 a.m. to 8 p.m., Central Time, daily bluecrossmn.com/medicare
Social Security Administration 1-800-772-1213
TTY users call 1-800-325-0778
7 a.m. to 7 p.m., Monday through Friday ssa.gov
Medicare
1-800-MEDICARE (1-800-633-4227) TTY users call 1-877-486-2048 24 hours a day, daily
medicare.gov
NOTES:
bluecrossmn.com/medicare
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