Frequently Asked Questions (FAQs) About Medicare

Below we've answered some common Medicare questions.

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Medicare is a type of health insurance for individuals who are 65 or older, under 65 with certain disabilities, or any age with permanent kidney failure (called "End-Stage Renal Disease"). You must have entered the United States lawfully and lived in the country for five (5) years to be eligible for Medicare.

Medicare Part A (hospital insurance) helps pay for inpatient care you get in a hospital, skilled nursing facility, hospice, and for home-healthcare (if you meet certain conditions). Most people don't have to pay a monthly premium for Medicare Part A because they or a spouse paid Medicare taxes while working in the United States. If you don't automatically get premium-free Part A, you may still be able to enroll, and pay a premium. Learn more about Medicare Part A coverage.

Medicare Part B (medical insurance) helps pay for medically-necessary doctors' visits, services and other outpatient care. It also pays for some preventive services (like flu shots) to help keep you healthy. Learn more about Medicare Part B coverage.

Original Medicare: Managed by the Federal government, it provides your Medicare Part A and Part B coverage. You can choose to have either one, or both parts. You have to pay a deductible, and you are usually charged coinsurance each time you receive services. You can add Medicare prescription drug coverage (Part D) by joining a Medicare Prescription Drug Plan (PDP). In order to join a PDP plan, you must have Medicare Part A, Part B, or both. Costs and benefits vary by plan. You can also choose to buy a Medicare Supplement Insurance policy* to help pay your share of covered out-of-pocket expenses not covered by Medicare, such as copays, coinsurance, and deductibles.

*Medicare Supplement Insurance Plans and their insurers are not connected with or endorsed by the United States government or the federal Medicare program.

Medicare Advantage Plans (Part C): You must have both Medicare Part A and Part B to join one of these plans. The plans provide all of your Part A and Part B services and generally provide additional services. You usually pay a monthly premium, and copays, that will likely be less than the coinsurance and deductibles under Original Medicare. In many cases, these plans also include Medicare Part D prescription drug coverage. These plans are health plan options that are part of the Medicare program. Costs and benefits vary by plan.

Medicare Advantage plans (sometimes called "Part C" or "MA Plans") are health plan options that are part of the Medicare program. Medicare Advantage plans provide all Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Advantage plans may also include Medicare Part D drug coverage plus extra coverage, such as vision, hearing, dental, and/or health and wellness programs. These plans are available as stand-alone health plans or with prescription drug coverage (called MA-PD plans).

To join a Medicare Advantage Plan, you must have both Medicare Part A and Part B. When you join a Medicare Advantage plan, you will still have to pay your monthly Part B premium. In addition, you may have to pay a monthly premium to your MA Plan. Find out more about Medicare Advantage Plans.

With a Medicare Advantage Network Private Fee-for-Service Plan, you're not locked into a defined network of doctors and hospitals. These plans give you the freedom to choose which doctors, specialists, and hospitals you visit. However, you may pay less for services received from healthcare providers who are in the plan’s network. You may see a specialist without a referral. And, there is no limit on covered office visits so you can see your doctor as often as you choose. Providers in the network can change at any time. Learn more about our Medicare Advantage PFFS plan.

When you join a PFFS plan, you're still enrolled in the Medicare program and entitled to all medically necessary healthcare services that are Medicare-approved. As a member, however, you'll enjoy the added advantages of low copays for doctor and hospital visits and coverage for preventive services. You have the freedom to choose any doctor, specialist, or hospital in the U.S. that accepts the terms and conditions of the plan. Learn more about Today's Options PFFS plans.

PPO plans are a type of Medicare Advantage Plan that includes all Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits. PPO plans may also include Medicare Part D drug coverage plus extra benefits and services not covered by Original Medicare. A PPO plan has a list (called a "network") of doctors and specialists that you may go to. However, you have the flexibility to go to any doctors, specialists, or hospitals that aren't on the plan's list (additional fees may apply). Learn more about Medicare Advantage PPO plans.

HMO plans are a type of Medicare Advantage Plan (Part C) that includes all your Part A (hospital insurance) and Part B (medical insurance) benefits. HMOs may also cover Medicare Part D drug coverage plus additional benefits, like extra days in the hospital, and dental and vision care not covered by Original Medicare. With most HMOs, you can only go to doctors, specialists, or hospitals in the plan's network, except in an emergency or urgent care situation. That allows us to offer you significant savings over Original Medicare. Learn more about Medicare Advantage HMO plans.

By working with a select team of doctors and hospitals, HMOs are able to keep costs low. When you join an HMO plan, you will choose a doctor from our network to coordinate your care. There is no limit on covered office visits, so you can see your doctor as often as you choose. If you wish to change your doctor, also called your Primary Care Physician (PCP), you may do so at any time. Your PCP is your health advocate - he or she will send you to specialists or hospitals when you need additional care.

Please note that, with an HMO plan, you must use providers in the network. You will be responsible for any fees or services provided by doctors or hospitals out of the network. Providers in the network can change at any time.

When you join an HMO, you're still enrolled in the Medicare program and entitled to all medically necessary healthcare services that are Medicare-approved. However, as an HMO member, you will enjoy deductibles, copays, and coinsurance amounts that may be substantially lower than those under Original Medicare.

If you join a Medicare Advantage plan, your Medicare Supplement Insurance policy won't work. This means it won't pay any deductibles, copayments, or other cost-sharing.

Note: Medicare Supplement Insurance Plans and their insurers are not connected with or endorsed by the United States government or the federal Medicare program.

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan that includes all of the benefits of Original Medicare plus the additional benefits of prescription drug coverage. This type of plan provides focused and specialized care for specific groups of people. Coverage benefits, provider choice and drug formularies are tailored to the needs of the specific groups they serve.

You must have both Medicare Part A (hospital insurance) and Part B (medical insurance) benefits to qualify. You can join a SNP plan at any time. Each year, insurance companies offering Medicare SNPs can decide to join or leave Medicare.

Universal American is the parent company of TexanPlus® and Today's Options®. We have been on the cutting edge of Medicare healthcare for over two decades, pioneering innovative collaborations between patients, doctors and our company to produce healthy outcomes for all, while making healthcare more effective and affordable.

We offer an array of Medicare Advantage plans to people eligible for Medicare in Texas, New York, and Maine. Our TexanPlus® and Today's Options® brands offer a range of coverage options, including Medicare Advantage HMO's (Health Maintenance Organizations), HMO-POS (Point of Service), HMO-SNPs (Special Needs Plans), PPOs (Preferred Provider Organizations), and PFFS (Private Fee-for-Service) plans. These include plans with Medicare prescription drug benefits.

You are not automatically enrolled in Medicare Part A and Part B unless you are already receiving Social Security or Railroad Retirement Board benefits prior to turning 65. If you are automatically enrolled, you should receive your Medicare card in the mail 3 months before your 65th birthday. If you do not get your card, or you are not receiving retirement benefits, you need to contact Social Security.

There is an enrollment window to sign up for Medicare. The window starts 3 months prior to your 65th birthday month, and includes your birthday month and the 3 months immediately following your birthday month. If you do not enroll during this window, you may have to wait to start your coverage. If you do not sign up for certain Parts of Medicare during your window, and do not have Medicare approved coverage, you may have to pay a penalty to enroll in those Parts for the rest of your life. However, there are special enrollment periods, if you qualify.

Check with your employer to see what will happen to your health coverage when you turn 65. Plans for many companies automatically become secondary to Medicare when you turn 65. In most cases, Medicare Part A (hospitalization) is free. Other Parts of Medicare have premiums that vary. Even though Medicare is operated by Social Security, enrollment is separate unless you are already receiving Social Security or Railroad Retirement Board benefits when you turn 65. If you have Medicare approved coverage from your employer, in most cases, you will have a special Medicare enrollment period when that coverage ends.

Original Medicare does not cover most prescription drug costs. You must enroll in a Medicare approved insurance plan for Part D coverage or in a Medicare Advantage plan that includes Part D coverage to get prescription drug coverage. Each plan varies in the cost and the drugs that are covered. If you do not enroll in a Part D plan or go 63 consecutive days without “creditable prescription drug coverage,” you may have to pay a penalty for each full month you were eligible and did not have prescription drug coverage. This penalty may be applied for the rest of your life. Unless there are special circumstances, you cannot sign up for drug coverage whenever you choose.

If you do not have Medicare approved Part B coverage and later decide to add the coverage, you may have to pay a penalty for the rest of your life based on each 12-month period you were not enrolled.

There is a period after your initial Medicare enrollment that you can make some adjustments in your plan. These include switching from original Medicare to a Medicare Advantage plan or enrolling in a Part D prescription drug plan. Otherwise, in most cases, you will have to wait until the Annual Election Period each year (currently October 15 – December 7) to change plans or make adjustments in your currently plan. Those changes will take effect on January 1 of the following year.


Enrollment disclaimer information:
A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency. Providers can find the plan's terms and conditions of payment on our website at: www.TodaysOptions.com. Out-of-network/non-contracted providers are under no obligation to treat Today's Options PPO members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. For TexanPlus HMO-SNP: This plan is available to anyone who has both Medical Assistance from the State and Medicare.

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