AHIP Medicare Prescription Drug Plan Guide

1.	Medicare Has Several Parts

2.	Becoming Eligible

3.	Who is Eligible

4.	Choices for Health Care Coverage

5.	Choices for Prescription Drug Coverage

6.	Payments

7.	Medicare Coverage Requirements

8.	Qualifying for Extra Help

9.	Signing Up

10.	Changing Your Plan

STEP 2: Find the Plan That's Best for You

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4. Choices for Health Care Coverage

Medicare gives you two choices for your health care coverage.

Choice One:
Original Medicare (Medicare Parts A & B). Sometimes called Medicare fee-for-service.

	In most cases, Medicare pays each health care provider separately for each service you receive.
	You can visit any hospital or doctor that accepts Medicare.
	For most doctor services, Medicare pays 80% of the cost of the service. You pay the remainder.
	If you choose Original Medicare, you may also buy an additional health insurance plan, known as a Medicare Supplement (Medigap) Plan, to help you pay for your share of doctor and hospital costs (cost-sharing) that Medicare does not cover. You will learn more about this on the next screen "Choices for Prescription Drug Coverage".
	If you choose Original Medicare, you may also enroll in a stand-alone Medicare Prescription Drug Plan (PDP) for your prescription drug coverage.
	All persons on Medicare receive a red, white, and blue Medicare card from the government.

About Medicare Supplement (Medigap) Plans:
If you are in Original Medicare, you may purchase a Medigap Plan to cover many of your costs (cost-sharing) for hospital and doctor services that Medicare does not cover.

	You may not purchase a NEW Medigap policy that covers prescription drug costs. To cover drug costs, you should enroll in either a stand-alone drug plan or a Medicare health plan.
	If you already have a Medigap policy that covers some prescription drug costs, you can keep your Medigap Plan or you can enroll in a Medicare drug plan. If you enroll in a Medicare drug plan, contact the company that provides your Medigap insurance to tell them. They will then remove the drug portion of your Medigap coverage and adjust your Medigap insurance premium downward.

Choice Two:
Medicare Advantage and Medicare Cost Plans. They combine Medicare Parts A & B into one private insurance plan.

	Medicare health plans allow you to choose to get your Medicare coverage through a private insurance plan that has a contract with Medicare. The private insurance plan covers your Medicare Parts A & B benefits.
	Medicare health plans cover the hospital and doctor services covered in Original Medicare.
	Most Medicare Advantage plans also include prescription drug coverage. These plans are called Medicare Advantage Prescription Drug (MA-PD) Plans.
	Many Medicare Cost Plans and Private Fee-for-Service Plans offer the prescription drug benefit; some do not.
	You pay one monthly premium to your Medicare health plan for your doctor, hospital, and prescription drug benefits. Sometimes your plan premium can be as low as $0.
	Medicare health plans may have lower out of pocket costs than Original Medicare. For example, many provide a cap on what you must pay out of pocket for your doctor and hospital services each year.
	Medicare health plans will help you coordinate your health care coverage. They also may cover more services. For example, some cover additional preventive care. Some cover dental and/or eye benefits. Some offer benefits like limited transportation to help you get to and from medical appointments.With a Medicare health plan, you probably will not need a Medicare Supplement Plan.
	To get the best value from your Medicare health plan, you may need to see providers who participate in your plan's network. (Be sure to check with your plan about in-network and out-of-network coverage.)
	If you are enrolled in a Medicare health plan, you will receive a red, white, and blue Medicare card from the government. You also will receive a card from your Medicare health plan. It is your Medicare health plan card that you use when you go to the doctor or hospital.

You can choose from five kinds of Medicare health plans.
Medicare Advantage Health Maintenance Organizations (HMOs)

	In general, HMOs will ask you to use providers who belong to the plan's network. In most HMOs, in most cases you are covered only when you go to doctors, specialists, and hospitals on the plan's list, except in an emergency.
	Some HMOs allow you to use providers outside of the plan's network. However, using providers outside the plan's network will generally cost you more.
	If you choose an HMO and you also want to enroll in the Medicare prescription drug benefit, you will be required to get your drug benefit from your HMO.

Medicare Advantage Preferred Provider Organizations (PPOs)

	PPOs are similar to HMOs (see section above on HMOs), but you may use non-network providers, generally at a higher cost.
	If you choose a PPO and you also want to enroll in the Medicare prescription drug benefit, you will get your drug benefit from your PPO.

Medicare Advantage Private Fee-for-Service (PFFS) Plans

	PFFS Plans allow you to go to any Medicare-approved provider that will accept your PFFS Plan's terms and conditions of payment.
	Many PFFS Plans also include prescription drug coverage.
	If you choose a PFFS Plan that does not include prescription drug coverage, you may select a stand-alone Medicare Prescription Drug Plan.

Medicare Cost Plans

	These are a type of HMO.
	Many Medicare Cost Plans also offer prescription drug coverage.
	If you choose a Medicare Cost Plan you may get your drug benefit from the cost plan or from a stand-alone Medicare Prescription Drug Plan (PDP).

Medicare Advantage Medical Savings Accounts (MSAs)
If you choose this option, many of your medical (doctor and hospital) expenses will be covered initially through a tax-free, interest-bearing account funded by Medicare. If you spend all of the money in your account, you must pay out of your pocket until you reach the plan’s high deductible amount. If your expenses go above the high deductible, your health plan will cover all Medicare-covered services. You may have a copay or coinsurance.

	Any amount in your account that you do not use in the course of the year will remain in your account for future years.
	MSAs DO NOT provide the Medicare prescription drug benefit. If you choose an MSA and you also want to enroll in the Medicare prescription drug benefit, you must purchase a stand-alone Medicare Prescription Drug Plan.
	In 2008, MSAs are not likely to be available in every community.

If you have special health care needs
Medicare health plans may have extra benefits and services such as additional preventive care, care coordination, and transportation to and from medical appointments.

In some communities, there are Medicare health plans that focus on providing care for persons on Medicare who are eligible for both Medicare and Medicaid, live in a health care institution, or have serious chronic conditions. These programs are called Medicare Special Needs Plans (SNPs). They include the Medicare drug benefit.

In some communities, there are programs that coordinate and provide preventive, primary, acute, and long-term care services so that older persons can continue to live in the community. They also cover prescription drugs. These programs are called Programs of All-inclusive Care for the Elderly (PACE). There are no premiums to pay for people who qualify for Medicaid. For more information, go to www.NPAOnline.org.

Talk with the health plans that are available in your community about the services they provide. Or, go to medicare.gov, or ask a State Health Insurance Assistance Program (SHIP) counselor.