Frequently Asked Questions (FAQs) About Medicare

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure (called "End-Stage Renal Disease"). You must have entered the United States lawfully and have lived here 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, or 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.

Medicare Part B (medical insurance) helps pay for medically-necessary doctors, services and other outpatient care. It also pays for some preventive services (like flu shots) to help keep you healthy and some services that keep certain illnesses from getting worse.

• 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 or 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 copayments, 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 (called Part C) You must have both Medicare Parts A and 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 offer 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) coverage and cover all of the services that Original Medicare covers with the exception of hospice care. Medicare Advantage plans may offer 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 Medicare Part B premium. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan.

A Medicare Advantage Private Fee-for-Service (PFFS) plan is a type of Medicare Advantage plan (Part C) in which you have the freedom to choose any doctor or hospital that accepts the plan's terms and conditions. The health plan, rather than the Medicare Program, decides what you'll pay for the services you will receive. Some of the advantages of the Medicare Advantage PFFS plans are that you may pay less for Medicare-covered benefits and may have extra benefits Original Medicare doesn't cover. These plans are available as stand-alone health plans or with prescription drug coverage (called MA-PD plans).

*A Private Fee-for-Service plan is not a Medicare supplement plan. 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.

With a Medicare Advantage Network Private Fee-for-Service Plan, you're not locked into a defined network of doctors and hospitals. Our plan gives 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 our broad 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.

*A Private Fee-for-Service plan is not a Medicare supplement plan. 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.

PPO plans are a type of Medicare Advantage Plan that includes all Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits. These plans are designed to reduce the cost of healthcare by contracting with certain doctors, labs, and hospitals to provide care at a discounted rate for members. A PPO plan has a list (called a "network") of Primary Care Physicians, specialists, hospitals, and other providers 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. You might pay more for services that are received outside of the network. In addition, special rules for authorization may apply.

No. Our plan gives you the freedom to choose which doctors, specialists, and hospitals you visit. You may pay less for services received from healthcare providers who are in our broad 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.

Note: With a PPO, your plan will still cover a percentage of the cost when you choose an out-of-network provider for all covered services, as long as they are medically necessary. With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers.

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 additional benefits, like extra days in the hospital, and dental and vision care. 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.

By working with a select team of doctors and hospitals, HMOs are able to keep costs low. When you join an HMO, you will choose a doctor from our broad 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 a HMO member, you will enjoy deductibles, copayments, and coinsurance amounts that may be substantially lower than those under Original Medicare.

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. With a Today's Options PFFS plan, you are not locked into a network of doctors and hospitals. We do not require a referral to see a specialist, and there is no limit on covered office visits so you can see your doctor as often as you choose.

*A Private Fee-for-Service plan is not a Medicare supplement plan. 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.

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. Therefore, you may want to drop your Medicare Supplement Insurance plan if you join a Medicare Advantage plan. However, you have a legal right to keep the Medicare Supplement Insurance plan.

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