Frequently Asked Medicare Questions

Q: What is 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 5 years to be eligible for Medicare.

Q: What is Medicare Part A?

Medicare Part A (Hospital Insurance) helps pay for inpatient care you get in a hospital, skilled nursing facility, or hospice, and for home-health care 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.

Q: What is Medicare Part B?

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. Most people pay the standard monthly Medicare Part B premium.

Q: What are my main choices for getting Medicare 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 get services. You can add Medicare prescription drug coverage (Part D) by joining a Medicare Prescription Drug Plan. Costs and benefits vary by plan. You can also choose to buy a Medigap (Medicare Supplement Insurance) policy to help pay some of the health care costs’ “gaps” (like copayments, coinsurance, and deductibles).
• 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 most cases, these plans also offer Part D prescription drug coverage. These plans are offered by private insurance companies approved by Medicare. Costs and benefits vary by plan.

Q: What type of Medicare Advantage plans does Universal American’s family of companies offer?

• Private Fee-for-Service Plans
  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 Medicare and the plan’s terms and conditions. The insurance plan, rather than the Medicare Program, decides what you’ll pay for the services you will receive. You may pay less for Medicare-covered benefits. You may have extra benefits the Original Medicare Plan doesn’t cover. These plans are available as stand-alone health plans or with prescription drug coverage (called MA-PD plans).
• PPO (Preferred Provider Organization) Plans
  Medicare Advantage Preferred Provider Organization (PPO) 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 its members. You will save the most when you utilize our comprehensive network of care providers, but a PPO will also pay a portion of your healthcare costs if you choose a doctor or hospital that isn’t in the network, but agree to accept the plan’s payment terms and conditions.
• HMO (Health Maintenance Organization) Plans
  Medicare Advantage Health Maintenance Organization (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. Your costs with a Medicare Advantage HMO plan may be lower than in Original Medicare. Medicare Advantage HMOs also cover additional benefits, like extra days in the hospital, and dental and vision care. With most Medicare Advantage HMOs, you can only go to doctors, specialists, or hospitals in the plan’s network, except in an emergency.

Q: What is a Medicare Part D Prescription Drug Plan?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future. Our affordable Medicare Part D Prescription Drug Plans offer you coverage on medicines not covered under Medicare Part B.

Q: Am I eligible for a Medicare Part D Prescription Drug Plan?

You must be entitled for Medicare benefits under Medicare Part A and/or enrolled in Medicare Part B to be eligible for our Part D plans. Please note that you can only be enrolled in one Medicare prescription drug plan at a time.

Medicare beneficiaries are entitled to enroll in or switch their Medicare Prescription Drug Coverage (Medicare Part D) between November 15 and December 31, for an effective date of January 1st.

There are other times when you may be able to sign up or switch prescription drug plans. If you are turning 65 and are new to Medicare, you can enroll in a plan up to three full months before your birth month and up to three months after. If you are enrolled in Medicare and Medicaid, you can switch at any time.

Q: What drugs are excluded from the Medicare Part D Prescription Drug Plans (PDP) and Medicare Advantage Prescription Drug Plans (MA-PD)?

The drugs excluded by Medicare are:

• Medications used to treat anorexia, weight loss, or weight gain
• Medications used to promote fertility
• Medications used for cosmetic purposes or hair growth
• Medications used to treat erectile dysfunction
• Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparation
• Non-prescription drugs

Outpatient medications for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale.

In addition, if a medication is covered by Medicare Parts A or B, it cannot be covered under Part D (Medicare Advantage Plans with Prescription Drug coverage or Medicare Prescription Drug Plans). Some examples of Parts A or B medications include: diabetic test strips, injectables solely administered in the physician’s office and medications administered in the hospital. Also, each Medicare Advantage Prescription Drug Plan and Medicare Prescription Drug Plan may have its own specific exclusions.

Q: How do I know if I can receive Extra Help?

You may qualify for Extra Help to pay for your Medicare prescription drug plan premiums. To see if you qualify for getting Extra Help, call:

• Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week.
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday (TTY users should call 1-800-325-0778).
• Your state Medicaid office for more information.