Navigating Medicare Options Guide

© Copyright New Horizons Un-Limited Inc

This guide provides an overview of Medicare options. Be sure to consult the Social Security Administration, your Medicare agent, or your insurance provider before making a final decision, as changes may occur annually.
Contact information is available at the end of this article.

Key Differences Between Original Medicare and Medicare Advantage

Original Medicare

  • No Annual Out of Pocket Limit: Expenses can accumulate indefinitely.
  • Standard 20% Coinsurance: Applies to most services after meeting the deductible
  • Separate Part D Prescription Drug Coverage: Required for medications.
  • Additional Medicap Insurance: Often needed to help cover higher out-of-.pocket.

Medicare Advantage

  • Annual Out-of-Pocket Maximum: Caps total spending for the year.
  • Varied Copay Amounts: Depend on the service and provider within the network.
  • Prescription Drug Coverage: Often included in the plan.
  • Additional Benefits: May include:
    • Allowances for over-the-counter products.
    • Free fitness memberships.
    • Cash allowances for utility bills.
    • Free transportation services.

Important considerations

Provider Network:

  • Medicare Advantage Plans:
    • Typically limit coverage to a network of providers, requiring you to stay within the network for best coverage.
  • Original Medicare:
    • Provides more freedom to choose health care providers.

Plan Flexibility

  • Original Medicare:
    • Offers greater flexibility allowing visits to any providers that accept Medicare.
  • Medicare Advantage Plans:
    • May have network restrictions.

Cost Comparison

  • Medicare Advantage Plans:
    • Usually have lower monthly premiums than Original Medicare.
    • However, total costs including premiums, copays, deductibles, and out-of-pocket maximums should be carefully considered.

Enrollment Periods

Medicare Open Enrollment Period

  • When:
    • October 15th-December 7th annually.
  • What You Can Do:
    • Join Switch or drop a Medicare Advantage Plan.
    • Change Medicare Advantage or Part D prescription drug plans.
  • Coverage Begins:
    • January 1 of the following year.

Medicare Advantage Open Enrollment Period.

  • When:
    • January-March 31st annually.
  • What you can do:
    • Switch to another Medicare Advantage Plan.
    • Drop a Medicare Advantage plan and return to Original Medicare.
    • Enroll in a separate Medicare Part D drug plan.

Special Enrollment Periods (SEPs):

You may be eligible to change your Medicare Plan during a Special Enrollment Period if:

  • You move to a new address.
  • You return to the U.S. after living abroad.
  • You live in or recently moved out of a facility (Nursing home or Rehabilitation hospital

How to Get More Information

For questions, coverage details or plan comparisons:

  • Call Medicare: 1-800-MEDICARE(800-633-4227)
    • TTY Users: 1-877-486-2048.
  • Contact: Your Health Insurance Agent: For detailed information on specific Medicare Advantage Plans.
  • Contact: Social Security Administration: For additional Medicare-related details.

Financial Assistance:

There are several nonprofit agencies can upon meeting disability and income requirement offer the following:

  • Medicare and Medicare Advantage premium reimbursement
  • Copays for prescriptions and Doctor visits
  • Patient advocate resources for various health conditions

A couple of notable examples are:

  • The Assistance Fund(TAF):
    • Phone: (855)845-3663 (Monday-Friday, 8am-7pm. ET, excluding holidays.)
    • Website: www.tafcares.org
  • Patient Advocate Foundation(PAF):

Prepared by Lou
New Horizons Un-Limited

-

-