What is the Affordable Care Act?
The Affordable Care Act is the health insurance reform legislation that was passed by Congress and signed into law by President Obama on March 23, 2010. For more information about The Affordable Care Act, visit www.medicare.gov(link opens in new window) , you can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also contact your State Health Insurance Assistance Program (SHIP). In Florida, the State Health Insurance Assistance Program is called Serving Health Insurance Needs of Elders (SHINE) www.FloridaShine.org(link opens in new window) . The toll free number is 1-800-963-5337; TTY users should call 711, Monday through Friday, 8 a.m. to 5 p.m. You can also write to: 4040 Esplanade Way, Suite 370, Tallahassee, FL 32399-7000.
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 generally automatically enrolled in Medicare hospital insurance (Part A) without a premium when you apply for Social Security benefits (if you have 10 years of creditable employment) – usually upon reaching 65 years of age or after receiving disability payments for two years. Part A helps cover inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B helps cover physician and outpatient hospital services.
The member is responsible for Part B payment of premium. The premium you pay for Part B is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but it doesn’t cover all of your healthcare costs. For example, you pay a deductible for each hospital stay and may typically pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.
What are the four parts of Medicare?
Following are the four parts to Medicare:
Medicare Part A is hospital insurance – that helps pay for hospital stays, rehabilitative nursing facilities, home health care, and hospice. Most people don’t have to pay a premium for Part A because it was prepaid through their payroll tax while they were working.
Medicare Part B is medical insurance – that helps pay for doctors’ services and outpatient care. There is a monthly premium for Part B paid for by the member. If you don’t sign up for Part B when you first become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but didn’t enroll.
Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private company like CarePlus that also provides additional benefits.
- Medicare Part D is prescription drug coverage. In one way, Part D is like Part B: If you don’t join at age 65, you may have to pay a penalty when you do join.
What is Medicare Advantage?
Medicare Advantage is a type of health plan that 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:
- Health Maintenance Organization plans (HMO)
- Preferred Provider Organization plans (PPO)
- Private Fee-for-Service plans (PFFS)
What is a Medicare Advantage HMO?
An HMO features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. Medicare Advantage HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, reduced cost sharing, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, you use it instead of your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.
What is the Medicare Part D drug benefit?
As of January 1, 2006, anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in a prescription drug benefit plan, Medicare Part D. This benefit was designed to help Medicare consumers handle the rising cost of drugs and give them easier access to prescription medications.
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 you like?
- Are you choosing a new doctor?
- Is freedom to go to any doctor and any hospital very important to you?
- Do you need a prescription drug plan?
- What are your current or previous health conditions?
- What prescription drugs are you currently taking?
- Are the drugs you take covered by the plan’s formulary?
- What does your doctor think about your healthcare needs?
What is a Prescription Drug Plan (PDP)?
A PDP is a private stand-alone prescription drug plan that offers coverage for prescription medications, Part D. This plan can be used with Original Medicare or a Medigap plan.
An individual cannot be enrolled in more than one PDP at the same time. For this same reason, an individual may not be enrolled in a PDP and a Medicare Advantage (MA) plan that also includes prescription drug coverage at the same time. Exceptions include MA Private Fee-For-Service (PFFS) plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.
If you’re considering a PDP, please keep the following in mind:
- Optional plan. A PDP is an option – not a requirement. However, if you don’t join a PDP or a Medicare Advantage plan, or have prescription drug plan as good as Medicare’s, you won’t have coverage for your prescription drugs and will have to pay a higher premium if you join later.
- Monthly premium. PDPs have a monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans, including CarePlus, offer medical and prescription drug coverage altogether for one monthly premium. CarePlus does not offer a stand alone prescription plan. You must continue to pay your Medicare Part B premium. The Part B premium may be covered through your State Medicaid Program.
- No overlap with Medicare Advantage. If you’re enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that’s the case, choosing a PDP isn’t necessary – in fact, getting a PDP would disenroll you from your Medicare Advantage coverage.
When can I actually enroll into a Medicare Advantage plan?
Here’s a quick review of the key dates for enrollment periods and other deadlines:
- October 1 – October 14, 2016: 2017 Benefit and premium information is available from all organizations, so you can shop, compare and be ready to enroll by October 15, 2016.
- October 15 – December 7, 2016 (Medicare Advantage Prescription Drug Plan Annual Election Period, AEP): Medicare beneficiaries can enroll in a 2017 Medicare health benefits plan, such as a Medicare Advantage HMO plan, or a stand-alone Prescription Drug Plan (PDP).
- January 1 – February 14, 2017 (Medicare Advantage Disenrollment Period): Beneficiaries that have a Medicare Advantage plan can disenroll from that plan and return to Original Medicare, but are no longer able to switch Medicare Advantage plans during this time. Medicare beneficiaries that disenroll from the Medicare Advantage plan may enroll in a stand-alone Prescription Drug Plan (PDP).
Where can I get more information about Medicare Advantage and prescription drug plans, Medical Assistance and my Social Security benefits?
For more information about Medicare Advantage or prescription drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:
Centers for Medicare & Medicaid Services (CMS)
24 hours a day, 7 days a week
For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).
Florida Medicaid (Agency for Health Care Administration)
1-888-419-3456; Press Option 2 for general information about Medicaid
Address: 2727 Mahan Drive, Tallahassee, FL 32308
Monday through Friday, 8 a.m. to 5 p.m.
Serving Health Insurance Needs of Elders (SHINE)
Address: 4040 Esplanade Way, Suite 270
Tallahassee, FL 32399-7000
Monday through Friday, 8 a.m. to 5 p.m.
For more information about Social Security or railroad retirement earnings, call or go online:
Social Security Administration (SSA)
1-800-772-1213 (Generally, you’ll have a shorter wait time if you call during the week after Tuesday.) https://www.ssa.gov/agency/contact/phone.html(link opens in new window)
Monday through Friday, 7 a.m. to 7 p.m.
U.S. Railroad Retirement Board
24 hours a day, 7 days a week
Address: 844 North Rush Street
Chicago IL, 60611-1275
Want to Learn More?
To find answers to frequently asked questions about CarePlus, please see the below booklets that will help you access your plan benefits and services.
Frequently Asked Questions Booklet
MyCarePlus Member Portal Frequently Asked Questions