Frequently Asked Questions
Answers to questions you may have about Original Medicare and the new Medicare health plan options
With the changes in Medicare, you may be confused about your options and which plans are best for you. Here’s some valuable Medicare information that outlines the upcoming changes to Medicare and the new Medicare Advantage plans that will help you make sense of your choices.
Q. What is Original Medicare?
A. Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services.
The premium you pay for Part B is deducted from your Social Security benefits. Medicare pays for many health care services and supplies, but it doesn’t cover all of your health care costs. For example, you pay a deductible for each hospital stay and coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited.
Q. What is Medicare Advantage?
A. Medicare Advantage is the new name for Medicare + Choice plans. This type of health plan is an alternative to Original Medicare and was created by the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003. Some examples of Medicare Advantage plans are:
- Medicare Health Maintenance Organization plans (HMO)
- Medicare Preferred Provider Organization plans (PPO)
- Medicare Private Fee-for-Service plans (PFFS)
Medicare Advantage HMO Plans feature fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care. Most CarePlus Medicare Advantage HMO Plans include prescription drug coverage.
Q. What is a Medicare Advantage HMO?
A. An HMO features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in co-insurance when you use in-network doctors, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage.
Q. What is the Medicare Part D drug benefit?
A. As of January 1, 2006, anyone entitled to Medicare Part A and enrolled in Medicare Part B, regardless of income, was eligible to enroll in a prescription drug benefit. This benefit was designed to help Medicare consumers handle the rising cost of drugs and give them easier access to prescription medications.
Q. What questions should I consider when choosing a Medicare health plan?
A. Before you select a plan, carefully consider the following questions:
- Do you already have a doctor you like?
- Are you choosing a new doctor?
- Is freedom to choose doctors and hospitals very important to you?
- Do you need a prescription drug plan?
- Do you have health problems today or old problems that may recur?
- What drugs are covered by the plan’s formulary?
- Does your doctor feel comfortable with the plan’s guidelines for your treatment?
Q. What is a Prescription Drug Plan (PDP)?
A. A PDP Plan is a Private Prescription Drug Plan that offers coverage for prescription drugs. This Plan can be used with "Original" Medicare or a Medigap Plan.
A part D eligible individual may not be enrolled in more than one PDP Plan at the same time. A Part D eligible individual may not be simultaneously enrolled in a PDP and a Medicare Advantage (MA) plan except for a MA Private Fee-For-Service (PFFS) plan that does not offer the part D benefit, a Medicare Savings Account (MSA), or unless otherwise provided under CMS waiver authority.
At this time, CarePlus Health Plans, Inc. does not offer a PDP plan.
If you’re considering a PDP, please keep the following in mind:
- Optional plan. A PDP is an option – not a requirement. However, if you don’t join a PDP when you become eligible, you’ll have to pay a higher premium if you join later.
- Monthly premium. PDPs have monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans, including CarePlus’s, have coverage for prescription drugs as a benefit without an additional monthly premium.
- No overlap with Medicare Advantage. If you’re enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that’s the case, choosing the PDP isn’t necessary – in fact, getting the PDP would require you to drop your Medicare Advantage coverage.
Q. I'm confused about the enrollment dates. Can you sort this out for me?
A. Here’s a quick review of the key dates and deadlines for the upcoming enrollment dates:
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October 1 – November 14, 2007: 2008 Benefit and premium information is available from all plans, so you can shop and compare and be ready to enroll by November 15, 2007.
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November 15 – December 31, 2007 (Annual Election Period, AEP):Medicare beneficiaries can enroll in a 2008 Medicare health benefits plan, such as a Medicare Advantage HMO plan, Original Medicare, or a stand-alone prescription drug plan (PDP).
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January 1 – March 31, 2008 (Open Enrollment Period, OEP): You are allowed to make one of the following changes to your health plan coverage:
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If you’re enrolled in a stand-alone PDP plan, you can only change to another Medicare Advantage plan with prescription drug coverage.
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If you have a Medicare Advantage plan with prescription drug coverage (MAPD), the new plan you choose must also include prescription drug coverage. You may also disenroll from an MAPD plan back to Original Medicare. To do so, however, you must also enroll in a stand-alone PDP Plan via a Special Election Period.
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If your Medicare Advantage plan doesn’t include prescription drug coverage, you can only switch to another plan that doesn’t include drug coverage or enroll in Original Medicare
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If you are enrolled in Original Medicare, you can only choose to enroll in a Medicare Advantage plan without prescription drug coverage.
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If you are enrolled in Original Medicare and a prescription drug plan, the new plan you choose must be a Medicare Advantage plan with prescription drug coverage.
Q. Where can I get more information about Medicare Advantage HMO plans and my Social Security benefits?
A. For more information you can call, or go online, for answers about your coverage:
Centers for Medicare and Medicaid Services
1-800-633-4227
TTY 1-877-486-2048
24 hours a day; seven days a week
www.medicare.gov
Social Security Administration
1-800-772-1213
TTY 1-800-325-0778
Monday through Friday, 7 a.m. to 7 p.m.
www.ssa.gov
Railroad Retirement Board
1-800-808-0772
TTY 312-751-4701
24 hours a day, 7 days a week
www.rrb.gov
Learn more about CarePlus Health Plans, Inc.’s Medicare Advantage plans by calling:1-800-793-9808. We are open 8:00 a.m. to 8:00 p.m, Monday through Sunday. Alternative technical assistance will be available on holidays to return your call within one business day. Hearing impaired call
TTY:1-877-245-7930
This Website is for individual Medicare coverage only.
CarePlus Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. You must be enrolled in Medicare Part B and entitled to Part A. You must reside in the service area of the Plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Limitations and co-payments apply.
For Access to Exceptions, Grievance, Appeals, and Coverage Determinations/Redeterminations Information , please see our Forms page.
The information in these pages is accurate as of 12/12/2007, and is subject to change without notice.
CMS: H1019_CPHP_2008_Website REV 3
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