November 30, 2008 Pamela Hassen, Vice President of Marketing and Senior Programs with Fidelis Care, offers the following tips.
Let's start with the basics, the A-B-C's. Explain the different Parts of Medicare.
Part A (Hospital Insurance)
Helps cover inpatient care in hospitals, skilled nursing facilities, hospice, home health care.
You don't usually pay a monthly premium if you or your spouse paid Medicare taxes while working.
Part B (Medical Insurance)
Helps cover doctors' services and outpatient care and some preventive services.
Most people pay a monthly premium ($96.40 in 2009).
Part C (Medicare Advantage Plans)
Is a health coverage choice run by private companies approved by Medicare; includes Part A, Part B and usually other coverage including prescription drugs.
Costs for items and services vary by plan.
Part D (Prescription Drug Coverage)
Helps cover the cost of prescription drugs; may help lower your prescription drug costs and protect against higher future costs.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare.
Depending upon income, some people can get extra help to pay for Part D premiums and copays.
What's the advantage of choosing a Medicare Advantage Plan over Original Medicare?
Medicare Advantage Plans provide all of your Part A and Part B coverage.
They may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs.
Most include Medicare prescription drug coverage.
Some Medicare Advantage Plans have provider networks (check first with your doctor or hospital to find out if they accept the plan).
What factors should seniors consider when selecting a Medicare Advantage plan?
Cost - What will you pay out-of-pocket, including premiums, deductibles and other cost-sharing (copays or coinsurance)? Every plan is different. This year, Fidelis Care lowered costs to save seniors money, with $0 monthly premiums and $0 copays for doctor and specialist visits. We even added a new plan that refunds members $36.50 each month on their Part B premium.
Benefits - Are extra benefits and services, like eye exams, dental benefits, hearing aids or emergency health care outside the U.S. covered?
Doctor and Hospital Choices - Can you see the doctor(s) and go to the hospital you want? Do you need a referral to see a specialist? Fidelis Care is unique, for example, in that we offer members access to an extensive provider network from New York City and Long Island to the Hudson Valley, Capital Region, and Central New York.
Convenience - Where are the doctor's offices? Hours? Accepting new patients?
Prescription Drugs - Are your drugs covered under the plan's formulary? What will your prescription drugs cost under the plan? Fidelis Care offers a prescription plan that covers generic drugs through the coverage gap for a $1 copay.
Pharmacy Choices - What ones can you use?
Quality and Performance - This varies among plans, doctors, hospitals and health care providers. Do your research.
When can seniors join, switch or drop a Medicare Advantage Plan?
When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability.
Between November 15 and December 31 each year. Your coverage will begin on January 1 of the following year.
Between January 1 and March 31 of each year. However, you cannot join or switch to a plan with prescription drug coverage during this time unless you already have Part D coverage.
Where can seniors researching Medicare Advantage plans go for more information?
Fidelis Care representatives can meet with Medicare-eligible seniors who want answers about Medicare Advantage coverage and benefits. To learn more about Fidelis Medicare Advantage or arrange to meet with a Fidelis Care representative, call 1-800-860-8707 (TTY: 1-800-558-1125) or visit FidelisCare.org.
Seniors can also visit the Centers for Medicare and Medicaid Services (CMS) online at Medicare.gov.
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