What’s Changed in Medicare? A new Federal law has brought many changes to the Medicare Program. These changes give you even more choices in how you get your health care benefits, including coverage for prescription drugs.
Medicare prescription drug coverage–Started in 2006 Medicare now offers prescription drug coverage.
* If you join a Medicare drug plan by May 15, 2006, you can still get Medicare drug coverage for 2006.
* If you wait until after May 15, 2006, to join a Medicare drug plan, you may have to pay a penalty (higher premium), and in most cases you won’t be able to join a Medicare drug plan until November 15–December 31 of any year.
Your Medicare drug coverage would begin January 1 of the following year. Medicare Advantage Plans and Other Medicare Health Plans Medicare Advantage Plans and other Medicare Health Plans now offer a wider variety of plans to choose from for your health care coverage, including prescription drug coverage in more areas of the country.
What’s Changed in Medigap (Medicare Supplement Insurance) policies? Federal law now gives you more choices in Medigap policies.
If you bought your Medigap policy before 1992 or live in Massachusetts, Minnesota, or Wisconsin, your Medigap policy may be called something different than “Medigap Plans A through L.” Changes to Medigap policies with prescription drug coverage The new Federal law that provided for Medicare to start offering prescription drug coverage on January 1, 2006, also made changes that affected Medigap policies that include prescription drug coverage.
* As of January 1, 2006, you can’t buy a new Medigap policy covering prescription drugs. Before you decide whether or not to buy a Medigap policy, there are a few things you should know about the Medicare Program and Medicare plans (the different ways you can get your Medicare coverage).
The next few pages give you a quick look at Medicare plans and how Medigap policies might work or not work with these plans. If you already know the basics about the Medicare Program and Medicare plans, turn to Section 3 “What You Need to Know About Medigap Policies,” which starts on page 11. If you want to learn more about the new Medicare prescription drug coverage and how this coverage affects Medigap policies.
“What is Medicare? Medicare is a health insurance program for
* people age 65 or older,
* people under age 65 with certain disabilities, and
* people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
* Part A (Hospital Insurance),
* Part B (Medical Insurance), and
* prescription drug coverage.
What is Medicare Part A? Medicare Part A helps cover your inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care).
It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits.
What is Medicare Part B? Medicare Part B helps cover your doctors’ services and outpatient care. It also covers some other medical services that Medicare Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care.
These services are covered when they are medically necessary. What is Medicare prescription drug coverage? Medicare started offering coverage for prescription drugs on January 1 , 2006.
Note: Medigap policies aren’t Medicare Advantage Plans or other Medicare Health Plans. What are Medicare Plans? Medicare plans are the different ways you can get your health care and prescription drug coverage in the Medicare Program.
Your Medicare plan choices include the following: * The Original Medicare Plan–Available nationwide. If you have this plan, you may want to buy a Medigap policy.
* Medicare Advantage Plans–Available in many areas. If you have one of these plans, you don’t need, and generally can’t use a Medigap policy.
Medicare Advantage Plans include Medicare Health Maintenance Organization (HMO) Plans Medicare Preferred Provider Organization (PPO) Plans Medicare Private Fee-for-Service (PFFS) Plans Medicare Special Needs Plans *
Other Medicare Health Plans (that aren’t Medicare Advantage Plans)–Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These other types of Medicare Health Plans include Medicare Cost Plans Demonstrations PACE (Programs of All-inclusive Care for the Elderly)
* Medicare Prescription Drug Plans–see pages 38-40. Medicare prescription drug coverage started January 1, 2006. The Medicare plan that you choose affects many things like cost, benefits, doctor and hospital choice, convenience, prescription drugs, and pharmacy choices.
No matter how you choose to get your health care or prescription drug coverage, you are still in the Medicare Program. Original Medicare Plan and Medigap policies at a glance If you get your health care from the Original Medicare Plan, you use your red, white, and blue Medicare card.
The card tells you if you have Medicare Part A, Part B, or both. You don’t need Medicare Part B to be in the Original Medicare Plan. However, you generally must have Medicare Part A and Part B to buy a Medigap policy.