Medicare Frequently Asked Questions

Answers to questions you may have about Original Medicare and the new Medicare health plan options.

With the changes in Medicare here is 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.

What is Original Medicare?

Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people less than 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.

What is Medicare Advantage?

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 plans feature prescription drug benefits, fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care.

What is a Medicare Advantage HMO?

An HMO is an alternative to Original Medicare and 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 doctors, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage. However, you can return to Original Medicare if you wish.

What questions should I consider when choosing a Medicare health plan?

Before you select a plan, carefully consider the following questions:

• Do you already have a doctor?
• Are you choosing a new doctor?
• Is freedom to choose doctors and hospitals necessary to you?
• Do you need a prescription drug plan?
• What drugs are covered by the plan’s formulary?
• Does your doctor feel comfortable with the plan’s guidelines
  for your treatment?

What is the new Medicare Part D drug benefit?

Beginning January 1, 2006, anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, can take advantage of a new prescription drug benefit. This benefit is designed to help Medicare consumers handle the rising cost of drugs and give them easier access to prescription medications.

What type of information can I expect to receive from Medicare about the PDP, and what are the enrollment dates?

Here’s a quick review of the key dates and deadlines for the upcoming enrollment dates:

• October 1 – November 14, 2010: 2011 Benefit and premium information is available from all plans, so you can shop and compare and be ready to enroll by November 15, 2010.
• November 15 – December 31, 2010 (Annual Election Period, AEP): Medicare beneficiaries can enroll in a 2011 Medicare health benefits plan, such as a Medicare Advantage HMO plan, Original Medicare, or a stand-alone prescription drug plan (PDP).

What is my monthly premium for HealthSun Health Plans?

You do not pay a separate monthly plan premium for HealthSun Health Plans.

What is Cost-Sharing?

Cost-sharing refers to amounts that a member has to pay when services or drugs are received. It includes any combination of the following three types of payments: (1) any deductible amount a plan may impose before services or drugs are covered; (2) any fixed “copayment” amount that a plan requires when a specific service or drug is received; or (3) any “coinsurance” amount, a percentage of the total amount paid for a service or drug, that a plan requires when a specific service or drug is received.

Where can I get more information about Medicare Advantage plans and my Social Security benefits?

For more Medicare information you can call – or go online – for answers about your coverage.

Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850
1-800-633-4227
TTY 1-877-486-2048
24 hours a day; seven days a week
www.medicare.gov

Social Security Administration
Office of Public Inquires
Windsor Park Blvd.
6401 Security Blvd.
Baltimore, MD 21235
1-800-772-1213
TTY 1-800-325-0778
Monday thru Friday
7 a.m. – 7 p.m.
www.ssa.gov

Railroad Retirement Board
Chicago District Office
844 N. Rush Street
Ninth Floor
Chicago, IL 60611-2092
1-800-808-0772
TTY 312-751-4701
24 hours a day, 7 days a week
www.rrb.gov

 

Learn more about HealthSun Health Plans, Inc.'s Medicare Advantage plans by calling 305-234-9292 or 1-877-207-4900 Monday though Friday from 8:30am – 8:30pm. Speech and hearing impaired call TTY: 1-877-206-0500.

This Website is for individual Medicare Coverage only.

HealthSun Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract with the Centers for Medicare & Medicaid Services (CMS) — Approved Benefits HMO Plans are available to anyone enrolled in Part B and entitled to Part A of Medicare through age or disability. Limitations and co-payments apply.

The information in these pages is accurate as of 1/1/2011, and is subject to change without notice.