Medicare Advantage Explained 2008 - OXHP › secure › materials › AARP_Medicare...Medicare Advantage Explained 3Choice is good, but… an informed choice is better. This guide

Medicare AdvantageExplained

2008

Getting More from

Your Medicare Benefi ts

An educational resource

from

Medicare Advantage Explained2

4 Medicare Basics

7 About Medicare Advantage

9 Medicare Advantage Options

12 Reviewing Your Choices

16 Frequently Asked Questions

18 Glossary

Medicare offers you a lot of choices. To make a wise decision, you should learn about the unique features of Medicare Advantage plans. This guide will introduce you to the basics.

Do you know that Medicare Advantage can give you more benefi ts at affordable prices?

Medicare Advantage Explained 3

Choice is good, but…

an informed choice is better. This guide will introduce you to your Medicare choices and help you understand if a Medicare Advantage plan could match your needs.

With Original Medicare Part A and Part B (which you may already have) you have two options to add to your benefi ts:1 Medicare supplemental insurance policy

(often called a “Medigap” policy)2 Part D prescription drug plan

Today, you have another alternative: a Medicare Advantage plan. These plans can help you get more for your health care dollar. This guide explains how, and tells you what to expect from a Medicare Advantage plan.

Medicare Advantage plans provide your Part A and Part B benefi ts, offer additional services beyond Part A and Part B benefi ts, and can include Medicare Part D prescription drug coverage. These plans emphasize preventive care and wellness, and often cost less than you are currently paying.

Explore this guide. Medicare Advantage plans simply make the Medicare benefi ts you’ve already earned work harder for you. Read this guide for a review of the basics of Medicare, then sort through all the Medicare Advantage coverage options and make decisions with confi dence.

With Medicare Advantage plans, your Medicare benefi ts work harder.


When are you eligible?

Original Medicare

Here’s a look at the basics of Original Medicare.

1 You are 65 years old

2 You are a U.S. citizen

3 You or your spouse has paid Social Security taxes for at least 10 years

Original Medicare Part A Original Medicare Part B

What’s covered? Part A covers medically necessary care for illness or medical conditions that involve overnight stay in the hospital, follow-up nursing care after a hospital stay, hospice care, and some home health care for the homebound.

Part B covers medically necessary care that does not require an overnight stay in the hospital, such as a doctor’s offi ce visit, hospital and clinic care not requiring overnight stays, lab tests, and some screening.

Offered by Federal government Federal government

Premium Part A is free for most people. Monthly fee based on income; in 2007, the average monthly premium is $93.50 per month.

Deductible Deductible required for each hospital stay; in 2007, amount is $992.

Annual deductible required before Part B begins to pay; 2007 deductible is $131.

Copayment Daily copayment required after hospital stay of a certain number of days.

Copayment applies for outpatient hospital services.

Coinsurance Small coinsurance payments apply to certain hospice care respite services.

For many Part B services, Part B usually pays 80% after the annual deductible is met, and you pay 20%.

Can I be refused

coverage?

No. You’re eligible whatever your medical history or pre-existing illness.

No. You’re eligible whatever your medical history or pre-existing illness.

Medicare Basics

Some younger people who have certain disabilities are also eligible for Medicare. If you’re one of those people, you can learn more about Medicare as it applies to you at www.medicare.gov.

5

Additional insurance coverage

If you have Original Medicare, you have the option to add two additional kinds of insurance coverage: stand-alone prescription drug plans and Medigap (Medicare Supplement) policies.

These options are offered by private companies instead of the federal government.

Part D Prescription Drug Coverage Medigap Policies

What’s covered? Plans cover prescription drugs you use that are included in the plan’s list of drugs covered, or formulary.

In general, Medigap policies cover you for costs that aren’t covered by Part A and Part B, like deductibles, copayments, and coinsurance.

Offered by Private insurance companies which must meet benefi ts standards set by the federal Medicare program.

Private insurance companies whose offerings are approved by state insurance departments

Premium Premiums are set by the company and approved by state regulators; they may vary widely.

Premiums are set by the company and approved by state regulators; they may vary widely.

Deductible Some plans charge an annual deductible, and some don’t.

Do not require deductibles of their own, except for some high-deductible policies.

Copayment Most plans charge a copayment each time you fi ll a prescription.

Do not require copayments of their own.

Coinsurance Some plans charge a percentage of the cost each time you fi ll a prescription.

Do not require coinsurance of their own.

Can I be refused

coverage?

No. Anyone eligible for Medicare can enroll in Part D.

During the six-month period after you join Part B, you have a right to buy any Medigap policy sold in your state. After that, you may have to answer medical questions, and the answers could determine whether the company will cover you and the amount it will charge you. Once you have a Medigap policy, it cannot be taken away from you as long as you pay your premium.

Medicare Basicscontinued

You don’t need to buy more policies to get more value from Medicare. Explore Medicare Advantage instead.

Medicare Advantage Explained


You may be surprised to learn that you can choose between two ways of receiving your Medicare benefi ts. You can receive your benefi ts directly through Original Medicare, and have options for additional insurance, or you can choose a Medicare Advantage plan that coordinates your benefi ts.

Medicare Basics

Original Medicare

is operated by federal government subcontractors. Medicare pays fees for your care directly to the doctors and hospitals you visit.

Medicare Advantage plans

are private health plans that contract with the federal government (the Centers for Medicare and Medicaid Services). For many people, Medicare Advantage plans are the best value in health care because they can offer health benefi ts detailed below at no additional monthly premium beyond the Medicare Part B premium.

Medicare Advantage Plans

offer the same coverage as Original Medicare Parts A and B, plus more. Medicare pays a fi xed fee to the plan for your care, and then the plan handles its own payments to doctors and hospitals. To join, you must also belong to Part B.

Part A gives you help with hospital costs.

Accessing Medicare through

Medicare Advantage Plans (Part C)

Accessing Medicare

Directly through Original Medicare

Part B helps with doctor’s care and outpatient care.

Part D stand-alone prescrip-tion drug plans can be added to help with the cost of prescrip-tion drugs.

Medigap (Medicare supplemen-tal insurance) policies can be added to fi ll in some of the gaps in Part A and Part B coverage.

Part D prescription drug

coverage is integrated with most Medicare Advantage plans. If you are in a private fee-for-service plan without drug cover-age, you may be able to choose a stand-alone drug plan.

Additional benefi ts are often included with Medicare Advan-tage plans. The most common extras are preventive care and other health care benefi ts. For example, vision services, hearing services, health screen-ing tests, nurse advice lines, etc., may be included. And some plans cap your out-of-pocket spending for the year.

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About Medicare Advantage60-Second Guide to Medicare AdvantageSeven Big Ideas to Understand

1

You’ll get additional benefi ts.

Medicare Advantage plans offer the same coverage as Original Medicare Parts A and B, plus extras that contribute to your health and wellness like annual physicals, vision care, and access to a nurse advice line. Many, but not all, also include a Part D prescription drug plan. Many plans also offer a cap on your annual out-of-pocket spending.

2

Different choices are available.

Medicare Advantage plans are available in several different versions, including plans for those with special needs. The most common are described on pages 9–11. All are offered by private insurance companies and meet or exceed Medicare standards. There’s a good chance, then, you’ll fi nd one that matches your needs.

3

You probably can’t be refused.

Medicare Advantage plans are open to everyone who’s eligible for Medicare, regardless of health status, with the exception of people with end-stage renal disease. There are no physicals or health questions. You can’t be refused, even if you have pre-existing conditions that might mean you are a greater risk.

4

Your Part B premium may be your only premium.

If you join a Medicare Advantage plan, you will still pay your usual monthly payment for Part B. Some plans don’t charge any additional premium, although some do. Each year, prices change, but because companies compete for your business, they work hard to keep premiums low.

5

You’ll pay a share of your costs.

With a Medicare Advantage plan, you’ll pay a share of your costs as you use services. Each plan has its own rules for deductibles, copayments, and other cost sharing, all different from the cost sharing in Part A and Part B. Some Medicare Advantage plans will even limit your out-of-pocket spending, a feature not offered with Original Medicare.

6

Where you live matters.

Medicare Advantage plans focus on a specifi c geographic area, like a county, state, or region. Not every plan is available everywhere.

Medicare Advantage plans build networks of doctors and hospitals in a region. These networks are usually big. So there’s a good chance you’ll fi nd your favorite doctor on the list.

If you travel a lot, you’ll have coverage for emergency care when you’re away from home in the U.S. Some plans provide emergency coverage worldwide.

7

You get the convenience of a single plan.

With a Medicare Advantage plan, you have the convenience of a single plan that covers hospital care, doctor’s care, and, if you like, prescription drug coverage, too. You have only one plan to choose, and one plan to keep track of.

Here’s how you get more benefi ts. Medicare contracts with private companies to offer Medicare Advantage plans to Medicare benefi ciaries. As individuals join these plans, Medicare pays the plan provider a monthly amount based on what it typically costs to provide Original Medicare-covered services in the plan’s area. The private companies then coordinate care and use the savings to offer you more benefi ts and services.


• Gaps in coverage, such as prescription drugs, vision services, or hearing services often lead to needs for additional supplemental coverage.

• Additional benefi ts reduce gaps in coverage.

• No annual limit on the hospital and medical expenses you may need to cover out of your own pocket

• Often have annual limits on the amounts you will have to pay to cover your hospital and medical expenses

• Prescription drug coverage not included; you must purchase a plan separately.

• Part D prescription drug coverage available, either integrated with the plan or as a separate stand-alone plan

• Coverage only within the U.S. • Emergency care available worldwide

• You pay deductibles and coinsurance when you use health care services.

• Copayments of a fi xed amount make cost sharing more predictable.

• Does not include many preventive care benefi ts • Typically includes preventive care benefi ts such as annual physicals, vision, hearing, and dental services, and 24-hour nurse advice lines

A good option if you only need basic medical and hospital benefi ts, without coverage for prescription drugs, vision, hearing, and other health care services

A good choice if you want more complete coverage and benefi ts than Original Medicare and prefer a low or no additional monthly fee

About Medicare AdvantageLower Costs, Expanded Coverage

Optional Insurance Coverage

You can add optional policies on to Original Medicare to fi ll some of the coverage gaps, and provide you with prescription drug coverage. You’ll need to purchase these policies separately, though, and handle additional premiums and paperwork.

Myth: In a Medicare Advantage plan, I’ll have to give up my trusted doctor.

Fact: Your doctor most likely partic ipates in one of these plans. Some of the plans allow you to see any doctor who accepts Medicare and is willing to accept payment from the plan.

Original Medicare (Parts A and B) Medicare Advantage


Medicare Advantage plans come in several different forms. With all Medicare Advantage plans, you will continue to pay your Part B premium. Other details of these plans will vary.

Many Medicare Advantage plans offer coordin-ated care. In those plans, you have a network of local doctors and hospitals to choose from. The doctors you see coordinate your care. It’s similar to coordinated care you may have received from your employer’s health plan.

Coordinating your care saves money. In Medicare Advantage, these savings are used to give you more benefi ts.

Coordinated care plans come in two types: Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). When you consider these plans, fi nd out whether the doctors you prefer to see belong to the plan. Not all doctors do.

Health Maintenance Organization (HMO)

You receive care through a broad group, or network, of local doctors and hospitals. Your primary care physician will oversee your care, and in some plans, refer you to specialists as necessary. Some plans give you the ability to see specialists without referrals. You may save the most money on your health care costs by joining a managed care plan; however, your choice of health care providers is more limited than with other plans. Some plans have point-of-service options in which you can see doctors outside the network at a higher copayment.

Preferred provider Organization (PPO)

You will generally only see health care providers within the plan’s network, but you’ll also have the fl exibility to seek services from any accepting physician or hospital outside of the network. Usually you will pay a higher copayment in exchange for the greater fl exibility.

Medicare Advantage OptionsCo0rdinated Care Plans

Network

FEDERAL RESERVE NOTE




Plan pays a bigger share for services inside network.

You pay all or most of the cost of services outside the network.


Coordinated care plans often share costs with you with fl at amount copayments that you can plan for.







Plan pays most of the cost of services, and you pay a share.

Private Fee-For-Service

Plans allow you to use any provider who is willing to accept payments from the plan.

Private Fee-For-Service (PFFS)

You get to choose from any of the doctors and hospitals that agree to accept the terms, conditions, and payment rates from the plan. These plans are generally the most fl exible; however, greater costs can be associated with these plans.

Find out whether your doctors and hospitals accept the plan you are considering. Not all doctors and hospitals do.

Medicare Advantage OptionsPrivate Fee-For-Service Plans

Private fee-for-service plans offer you more fl exibility about the doctors you see, although the cost may be higher.


Special versions of Medicare Advantage plans are available to people with special needs. If any of the following plan types seem to apply to you or a loved one, you’ll want to look more closely at what’s available in your area. See page 17 for resources that can help.

Low-Income Plan

Low-income plans are designed for those who are eligible for both Medicare and Medicaid assistance programs. They offer reduced premiums and copayments and may include additional services and benefi ts, like transportation.

Institutional Plan

Institutional plans are designed to meet the specifi c needs of those living in nursing homes or long-term care facilities.

Disease-Specifi c Plan

Disease-specifi c plans addresses the specifi c health needs of people who have certain chronic conditions like diabetes, congestive heart failure, or chronic obstructive pulmonary disease.

Some special needs plans assign a care advocate to monitor vulnerable participants. Care advocates can detect health problems early. That allows quick attention to the problem, helping avoid more severe health issues and expensive hospital stays.

Care Advocate

Medicare Advantage OptionsSpecial Needs Plans

Medicare Advantage special needs plans offer individual attention for people with complex health needs.


Larry

Larry is 65 and recently retired. Larry’s wife is encouraging him to exercise more. He does not take prescription drugs but wants the comfort of knowing the coverage is there when he needs it. He wants low-cost coverage, but a fi tness benefi t is his main interest.

Best plan choice for Larry: Medicare Advantage HMO plan with Part D prescription drug coverage and additional fi tness and wellness benefi ts

Why? Larry selected a Medicare Advantage HMO plan with prescription drug coverage. His plan offers a fi tness program benefi t as part of his coverage. It also includes other health and wellness programs that will complement Larry’s new retirement. While Larry does not take any prescription drugs, the Part D drug coverage is there if he needs it. And enrolling in a drug plan now helps Larry avoid “late enrollment” penalties later.

Carol

Carol is an active 70-year-old woman with some health issues to take care of. She wants the freedom to select the doctor and hospital of her choice at a moment’s notice. Cost is not a top concern if she has the peace of mind of being able to see doctors when and where she needs to.

Best plan choice for Carol: Medicare Advantage PPO plan with Part D prescription drug coverage

Why? The PPO plan Carol selected gives her access to a very broad list of doctors and hospitals. She’ll pay more to see a doctor outside of the network, but that’s okay with her. Under this plan, she also has Part D prescription drug coverage to meet her future prescription drug needs.

Reviewing Your ChoicesChoosing the Right Plan for You

To give you some ideas about health care coverage solutions that might work for you and your loved ones, here are examples of health care coverage decisions for a range of needs.


Mary

Mary is a 76-year-old widow who currently pays $200 per month for a Medicare supplement insurance (Medigap) policy. She has a chronic condition requiring daily use of a prescription medi cation. Mary has a local doctor she has seen for years and wants to keep. She is on a very limited income and is concerned about the cost of health care coverage.

Best plan choice for Mary: Medicare Advantage HMO plan with prescription drug coverage

Why? Mary’s doctor is part of the Medicare Advantage HMO plan she joined. She can see him and pay a low, predictable copayment for each visit. Because the drug Mary takes is on the plan’s formulary (list of drugs that are covered), she benefi ts from the Part D prescription drug coverage that is built into the plan with no additional monthly premium. By joining a Medicare Advantage HMO plan, Mary was able to drop her Medigap policy. That saved her $200 per month in monthly premiums.

Susan

Susan is an 68-year-old woman with limited income. She qualifi es for additional fi nancial assistance through the state where she lives but does not know how to apply for help. She struggles to pay for the drugs her doctor prescribes. And, she cannot afford a stand-alone Part D prescription drug plan.

Best plan choice for Susan: Medicare Advantage Low-Income Special Needs plan

Why? By choosing a Medicare Advantage Low-Income Special Needs plan, Susan gets comprehen-sive medical and prescription drug coverage with no additional monthly premium. Her Medicare Advan-tage plan not only will help her process the paper-work to enroll her on the Low-Income plan, but will also assist her in obtaining additional fi nancial support beyond her monthly Social Security check. She also gets Part D prescrip tion drug coverage with no premium and low out-of-pocket costs. She has the security of coverage from a cordinated plan that is a lot like the one she had when she was working.

Reviewing Your Choicescontinued


When you have evaluated your needs, done the research, and seen the value you can fi nd in your Medicare benefi ts, you’re ready for the next step.

Enrollment Options

Turning 65 or a new Medicare member

If you are turning 65 or otherwise newly eligible for Medicare, you can sign up right now for a Medicare Advantage plan. For enrollment information, contact your local Social Security offi ce or the plan you wish to join.

Already enrolled in a Part D or Medigap Plan

If you are already enrolled in Medicare, you can select a Medicare Advantage health plan for 2008 during the annual election period from November 15 through December 31, 2007. Contact the plan provider for the plan you want to join or visit www.medicare.gov to learn how you can enroll.

Switch Options

Already in a Part D or Medicare Advantage Plan

If you are already enrolled in a Medicare Advantage plan, you have an additional opportunity to make a change. From January 1, 2008, to March 31, 2008, you can change from your current plan to a similar plan. You can’t add or drop drug coverage in this period, but you can change to another plan of the type you currently have. See page 16 for more details about switch options.

Special Enrollment

Special enrollment guidelines apply if you move outside your plan’s service area, or if you have special needs or circumstances. Check www.medicare.gov for details.

Reviewing Your ChoicesEnrolling in Your Medicare Advantage Plan

Call 1.800.893.1530 or TTY 1.866.832. 8671 between 8:00 AM and 8:00 PM in your time zone for answers to your questions about Medicare Advantage plans.

Plan carefully. Decide with confi dence.

Choosing your Medicare coverage takes some thought and planning. Here are some steps you can take that will help you compare plans and choose one that meets your needs and preferences.

1Research your options to learn what plans and policies are available in your area.

2Compare your choices. There’s a worksheet on page 15 that you can use.

3If you have questions about the plans you’re considering, call the plan’s customer service number for help. They may be able to answer your questions quickly on the phone. Or make an appointment to talk with a representative of the plan about your questions.


Reviewing Your ChoicesPlan Comparison Worksheet

This worksheet can help you compare the key points of the Medicare choices you are considering when you use it to fi ll in information from plans you are looking at.

Plan 1 Plan 2 Plan 3

Cost

Annual premium

Annual deductible

Copayment amounts?

Coinsurance amounts?

Out-of-pocket maximum amount?

What does this out-of-pocket maximum include?

Coverage

Do my doctors accept this plan?

Do specialist visits need a referral?

Prescription drug coverage included?

Are my drugs in the plan’s drug list?

Copayments?

Preventive care

Annual health screenings?

Additional deductibles or copayments?

Routine eye care?

Routine hearing test?

Dental care?

Nurse help line?

Programs to help you stay fi t?


Am I eligible for Medicare Advantage?

If you are a Medicare benefi ciary who is eligible for Part A and Part B benefi ts, you are eligible to enroll in a Medicare Advantage plan (unless you have end-stage renal disease, although some exceptions do apply in this case).

What services are offered under Medicare

Advantage?

By law, Medicare Advantage plans must offer at minimum the same benefi ts that individuals receive under Medicare Parts A and B. Most Medicare Advantage plans cover many benefi ts that Medicare Part A and Part B do not generally provide, including vision, dental, and hearing services, preventive services like annual physicals, and coverage for emergency service while traveling outside the U.S.

Eye care Hearing Fitness Wellness Nurse helpline

Extra benefi ts may be bundled with the plan.

Does Medicare Advantage offer prescription

drug coverage?

Many, but not all, Medicare Advantage plans offer prescription drug coverage.

What is Medicare Advantage going to cost me?

Usually, but not always, your out-of-pocket costs under Medicare Advantage will be lower than the cost of a Medicare supplement (Medigap) policy. Keep in mind that costs do vary by plan and by region. Every plan offers different additional benefi ts and has different rates for these extra benefi ts (vision, hearing, dental, etc.). Every plan will give you details about costs in its Summary of Benefi ts document.

How do I sign up for Medicare Advantage?

Call 1.800.893.1530, TTY 1.866.832.8671 between 8:00 am and 8:00 pm in your time zone or visit www.aarpmedicarecomplete.com on or after November 15.

You can also sign up through 1-800-MEDICARE or www.medicare.gov.

To fi nd out more about which plans are available in your area, please visit www.medicare.gov to access the Medicare Personal Plan Finder. You can also contact your local senior advocacy organization or ask friends and family for recommendations.

What if I am already in a Part D prescription

drug plan today?

You still have a variety of Medicare options available to you during certain times of the year. (See the answer to the next question.) Contact AARP MedicareComplete for more information on the Part D coverage included in most Medicare Advantage plans.

When do I sign up for Medicare Advantage?

You will be able to sign up for a Medicare Advantage plan from November 15 to December 31, 2007, for coverage beginning on January 1, 2008. If you are not happy with the plan you choose, you may switch plans between January 1 and March 31, 2008. You must remain with whichever plan you select by March 31 for the remainder of 2008. You can also sign up for Medicare Advantage any time between the ages of 64 years and nine months to 65 years and 3 months.

What happens once I’ve signed up for Medicare

Advantage?

After you’ve signed up for your Medicare Advantage plan, your health care plan will send you an ID card in the mail. Make sure to use this card every time you visit your physician.

Frequently Asked QuestionsYour Medicare Advantage Questions Answered


Frequently Asked Questionscontinued

What are my copayments and deductibles for

Medicare Advantage?

Every Medicare Advantage plan has different copayments and deductibles; that’s why it’s important to review the plan details before making a decision. However, most Medicare Advantage plans have cost sharing that differs from Original Medicare Part A and Part B.

For example, under Original Medicare Part A, you’re responsible for the fi rst $992 of a hospital stay. In a typical Medicare Advantage plan, you might pay a $500 deductible for the same stay. Or in another plan you might pay a $250 daily copayment instead of any deductible.

Can I be denied coverage based on my health

status?

No, you can’t be denied the opportunity to enroll in a Medicare Advantage plan based on your health. Medicare Advantage plans do not conduct health screenings and cannot deny enrollment to an eligible individual based upon health status. This includes pre-existing conditions (an illness or condition you currently have). The only exception is for those who have end-stage renal disease (although some exceptions do apply in this case).

Do I pay more money for benefi ts that go

beyond what Original Medicare offers?

Every plan has different rates for these premium benefi ts (vision, hearing, dental, etc.), and every plan offers different benefi ts. That’s why it’s important to review the Medicare Advantage plan details before making a decision.

Helpful Resources

For information on Medicare Advantage call 1.800.893.1530, TTY 1.866.832.8671 between 8:00 am and 8:00 pm in your time zone.

Center for Medicare and Medicaid Services (CMS):Visit www.medicare.gov to order the CMS Medicare Handbook or call 1-800-MEDICARE.


Benefi ts

Items and services that are covered by your insurance plan. Medicare Advantage plans must provide all the same benefi ts covered by Medicare Part A and Medicare Part B. Many Medicare Advantage plans also offer additional benefi ts.

Catastrophic coverage

Medical or prescription drug coverage that puts a limit on the cost to you if you suffer a very serious or life-threatening illness.

Catastrophic medical costs

Costs incurred during a very serious and costly health problem that could be life threatening or cause life-long disability. The cost of medical services alone for this type of serious condition could cause you fi nancial hardship. Plans with out-of-pocket maximums will help protect you fi nancially in case of a catastrophic illness.

Coinsurance

A kind of cost-sharing where you pay a percentage of the cost of the service. In Original Medicare, this is a percentage of the Medicare-approved amount. In Medicare Advantage, coinsurance varies depending on the plan.

Copayment

A kind of cost sharing where you pay a pre-set, fl at amount for a service, such as a yearly physician’s check-up or a prescription drug.

Deductible

This is the amount you pay fi rst, before your plan starts to pay. This is usually a yearly fee. Many Medicare Advantage plans have low or no deductibles.

End-stage renal disease

Permanent kidney failure requiring dialysis or a kidney transplant.

Glossary

Formulary

The list of prescription drugs that are covered by a Part D plan. Formularies vary depending on the plan.

Medicare-Approved amount

The amount of money that Medicare has approved as the total amount that a doctor or hospital should be paid for a particular service. The total amount includes what Medicare pays, plus any cost sharing you pay.

Medicare Part A and Part B

(also known as Original Medicare)

Part A Medicare pays for inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Medicare Part B covers doctor’s visits, outpatient care, and some home health care. All Medicare Advantage plans must offer Part A and Part B coverage.

Medicare Part D prescription drug plans

These private plans offer prescription drug coverage that meets the standards established by Medicare. Other names for these plans include Part D prescription drug plans, PDPs, and MA-PDs. There is a minimum coverage requirement for all Part D plans.

Medicare Supplement policies

These are plans sold by private insurance companies that pay for some of the expenses not covered by Parts A and B. These are also known as Medigap policies. Sometimes employers offer supplemental coverage to their retired employees and their spouses.

Each plan has a specifi c list (often hundreds of drugs) that the plan will cover. That list is called the formulary.


Glossarycontinued

Original Medicare

(also known as Part A and Part B)

This is a fee-for-service health plan that lets you go to any doctor, hospital, or other health care provider who accepts Medicare and is accepting new Medicare patients. Original Medicare has cost sharing that includes annual deductibles, copayments, and coinsurance. Original Medicare has two parts: Part A (hospital) and Part B (doctor’s visits, outpatient care, and some home health care).

Out-of-pocket costs

These costs are the amounts you pay as your share of your costs in a plan after you have paid any premium. Out-of-pocket costs include deductibles, copayments, and coinsurance.

Out-of-pocket maximum

The highest amount of money you have to pay out of your pocket during a certain period of time for certain covered charges. Setting a maximum amount you will have to pay protects you.

Premium

The money, usually as a monthly fee, that you pay to have an insurance plan. Many Medicare Advantage plans do not have monthly premiums.

Prescription mail service

A program for receiving your prescription medica-tions through the mail. Mail service is used for main-tenance medications that you take on a continual basis. Mail service usually gives you a 90-day supply and the medication is delivered to your home.

Provider network

This is the group of doctors, hospitals, pharmacies, and other health care facilities that have contracted with an insurance plan to provide care to plan members.

24-hour nurse advice line

A toll-free number provided by your private health insurer staffed by nurses. You can call this number any time to get answers to your health-related questions.

This educational resource is provided by two organizations committed to senior health and well being.

About SecureHorizons®

Health Plans

SecureHorizons by UnitedHealthcare is one of the largest Medicare Advantage programs available and operates in all 50 states. SecureHorizons plans focus exclusively on the health care needs of people with Medicare.

SecureHorizons Medicare Advantage plans are offered by UnitedHealthcare Insurance Company and its affi liates, part of a larger organization led by UnitedHealth Group. UnitedHealth Group is an innovative leader in the health industry, serving more than 70 million Americans to help people achieve optimal health.

About AARP®

AARP is a nonprofi t, nonpartisan membership organization for people 50 and over, and is dedicated to enhancing the quality of life for everyone as they age. AARP offers value through information, advocacy, and service.

AARP endorses quality products that bring value to people over 50. AARP MedicareComplete® plans are available to members and non-members of AARP.

If you have questions about Medicare Advantage, call 1.800.893.1530 or TTY 1.866.832.8671 between 8:00 am and 8:00 pm in your time zone for additional information.


The Medicare Advantage Explained guide is an educational resource from AARP MedicareComplete provided through SecureHorizons.

The AARP® MedicareComplete® plans are endorsed by AARP, and UnitedHealthcare pays a fee to AARP and its affi liate for use of the AARP trademark and other services. Amounts paid are used for the general purposes of AARP and its members. The AARP MedicareComplete plans are available to all eligible Medicare benefi ciaries, including both members and non-members of AARP. AARP and the AARP logo are trademarks or registered trademarks of AARP. MedicareComplete is the registered trademark of United Healthcare Alliance, LLC.

For additional information on Medicare Advantage plans, call us at 1.800.893.1530 or TTY 1-866.832.8671 between 8:00 am and 8:00 pm in your time zone.

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Medicare Advantage Explained 2008 - OXHP › secure › materials › AARP_Medicare...Medicare Advantage Explained 3Choice is good, but… an informed choice is better. This guide