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Oregon Guide to Medicare Insurance Plans

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Oregon Guide to Medicare Insurance Plans 2017 Oregon Guide to Medicare Insurance Plans Second Edition SHIBA New to Medicare? Medicare starts at 65, no matter where you are or what you’re doing. Find out how Medicare will affect you. Go to medicarestartsat65.org. Go to medicarestartsat65.org. If a company is not listed, it may not be authorized to sell insurance in Oregon, it is new, it is suppressed, or information was unavailable by Feb. 1, 2017, for this consumer guide. Terms are defined in the glossary on Pages 77-81. Information supplied in this guide is in the public domain and may be copied and distributed without permission. This guide is produced by the Division of Financial Regulation, and SMP Senior Medicare Patrol . SHIBA is a statewide network of certified counselors volunteering in their community to help all Oregonians make educated Medicare decisions. To get help Call SHIBA: 800-722-4134 (toll-free). You will be asked to use the phone keypad to enter your ZIP code. Depending on where you live, your call may be routed to a local agency in your area or will be returned by one of the state SHIBA staff members. If you need to talk to state SHIBA staff, do not enter your ZIP code and your call will be directed to the Salem office. Learn more about SHIBA at oregonshiba.org. New to Medicare? Check out medicarestartsat65.org. Be sure to get your Medicare information from a reliable source (rather than family or friends) and document the contact to protect yourself with date, time, number you called from (calls are recorded), representative with whom you spoke, and what was said. • Social Security, 800-772-1213 for Medicare Parts A & B questions • 1-800-Medicare (800-633-4227) for Part D questions To give help Become a SHIBA certified counselor. Call SHIBA at 800-722-4134 (toll-free). Counselors must complete an application, go through our training program, and work with a SHIBA coordinator in their community. To apply online, go to oregon.gov/DCBS/shiba/volunteers/Pages/volunteer.aspx. Basics Drug Coverage Medigap Medicare Advantage Resources Glossary CONTENTS Table of contents The Basics .................................. 6-19 What is an Medicare Supplement Innovative plan? ................................................. 28 Your Medicare options ......................................... 7 Plan costs differ ................................................. 29 Part A – Original Medicare hospital insurance .... 8 When can I buy a Medigap policy? ................... 29 Part B – Original Medicare medical insurance .... 9 Medigap for enrollees younger than age 65 ...... 30 The ABCs – and D – of Medicare ..................... 10 Will I have to wait to use my Medigap? .............. 30 Enrollment periods ..............................................11 Medigap waiting periods .................................... 30 Part B Medicare preventive services ................. 13 Medigap coverage outside the United States .... 31 Preventive Visits ................................................ 14 Guaranteed Issue .............................................. 32 Original Medicare –ABN and DMEPOS ............ 15 What do Medigaps cover? ................................. 33 Veterans’ benefits and Medicare ....................... 16 Medicare Supplement (Medigap) Retiree Plans and Medicare .............................. 17 policy information .............................................. 34 Medicare and the Marketplace .......................... 18 Medigap policies by plan type ........................... 37 Medigap vs. Medicare Advantage Part D prescription Comparison chart .............................................. 47 drug coverage .......................... 20-27 Medicare Part D ................................................ 20 About Medicare Do I need prescription drug coverage? ............. 20 Advantage plans ...................... 48-73 What if I have prescription coverage? ............... 20 Medicare Advantage .......................................... 48 The late penalty ................................................. 20 Who can join a Medicare Advantage plan? ....... 48 Where do I get help choosing a prescription Medicare Advantage election periods and drug plan? .......................................................... 20 enrollment actions ............................................. 48 Can I switch plans?............................................ 21 Special Enrollment Periods (SEP) ..................... 49 Things to look for in a drug plan ........................ 21 Help comparing plans ........................................ 49 What are the out-of-pocket costs for Part D? .... 22 How do I select a plan? ..................................... 50 Can I have more than one prescription Prescription drug coverage ................................ 50 drug plan at a time? ........................................... 22 About Medicare Advantage dental coverage ..... 51 Extra Help and the Medicare Savings Program .. 23 Medicare Advantage Disenrollment Period ....... 51 More ways to pay for prescription drugs ............ 24 Medicare Special Needs Plans (SNPs) ............. 52 Part D standard benefit coverage terms ............ 24 Medicare Advantage plan contact information .. 54 Part D standard benefit, what you pay Medicare Advantage plans by County ............... 55 for drugs ............................................................ 25 Medicare Advantage plans ................................ 56 2017 stand-alone prescription drug plans .......... 26 Appeals ..........................................74 About Medigap plans ..............28-47 What is Medigap? .............................................. 28 Resources and publications ........ 76 What do Medicare Supplement SELECT plans offer? ........................................................ 28 Glossary ........................................ 77 5 Basics Drug Coverage Medigap Medicare Advantage Resources Glossary CONTENTS START HERE: Choose one option Option 1 or Option 2 Original Medicare If you want other options for coverage Part A Hospital and/or Part B Medical Medicare Advantage (Private Medicare) Note: Must have Medicare If you want If you Parts A and B to enroll supplemental want to add medical just drug coverage coverage Managed care Private-Fee-for- (HMOs, PPOs, Service plans etc.) (PFFS) Medigap Stand-alone With or without With or without prescription Pages 28-47 drug plans drug coverage drug coverage Pages 26-27 Pages 48-73 Pages 48-73 If you also want drug coverage May also choose If you have other Stand-alone coverage prescription available Stand-alone drug plans and need more prescription information, drug plans Pages 26-27 contact Pages 26-27 the source of your benefits ● Employer or union group plan: Plan customer service ● Military benefits: Your county Veterans Service Officer 800-692-9666 ● Medicaid: Your case manager or DHS, 800-282-8096 6 Basics Drug Coverage Medigap Medicare Advantage Resources Glossary CONTENTS Your Medicare options Enrolling in Medicare What is Medicare Part A If you are turning 65 and have already and Part B? applied for Social Security or Railroad Medicare Parts A and B, also known as Retirement Board benefits, you should get a Original Medicare, cover basic hospital and Medicare card and packet in the mail about medical services, but leave part of the cost three months before your birthday. for you to share. This guide also explains additional Medicare options for health and If you have not yet applied for retirement prescription drug coverage. benefits, youmust contact Social Security to enroll in Medicare or to see if you can Whichever Medicare path is best delay enrolling without penalty. You have for you, please: seven months surrounding your 65th birth month to enroll, but benefits are delayed the 1. Make sure your providers, including longer you wait. See the table on Page 11 hospitals, accept your insurance. Call for details. your plan. If you miss the seven-month enrollment 2. Make sure your plan covers your pre- period at age 65, you can enroll from Jan. 1 scription drugs. Use the Medicare through March 31 each year, with benefits Health and Drug Plan Finder at beginning July 1. However, you may be medicare.gov or call your plan to penalized for late enrollment. find out. Social Security is the agency that deter- 3. Keep records. Document phone calls mines eligibility, premiums, and penalties. with the date, time, number from which If you have questions about enrollment into you called, name of person with whom Medicare, call Social Security at 800-772- you spoke, and the information you 1213 (toll-free). Always keep a record of the received. date, time, and name of the service repre- sentative. Remember to take accurate notes. 4. Call Social Security for information on enrolling in Parts A and B. Call Medicare at 800-MEDICARE or (800- 633-4227 toll-free) for information on benefits, claims, or Part D drug cov- erage. ALWAYS document the date and name of the customer service representative. 7 Basics Drug Coverage Medigap Medicare Advantage Resources Glossary CONTENTS Part A – Original Medicare hospital insurance 2017 Part A Premium Fewer than 30 credits, $413; 30-39 credits, $227. Most people have no premium if they have 40 or more work credits. Check with Social Security for work credits. Service Benefit You pay Hospitalization First 60 days $1,316 deductible per benefit Inpatient, not observation; period. You could pay multiple semiprivate room and board, deductibles in a calendar year. A general nursing, and deductible is required if
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