For most of our working lives, our health insurance needs are met through our employer. Employer group health plans offer a wide range of options and are very good at providing the health coverage that employees need. Many of you are here because you are either Medicare eligible today or soon will be.

Deciding which type of Medicare plan best replaces your employer health plan can seem daunting at first. We are here to make the process of evaluating your options as easy to understand as possible. Our number one goal is to empower you with the knowledge to make an informed and confident decision. Click on the "Medicare" tab to begin.

Medicare Information

Overview - Provides a brief and simple description of Original Medicare
Learn More - Defines Medicare Parts A, B, C and D..
Next Steps - Empowers you by clarifying your individual healthcare priorities and is the beginning of the plan evaluation process.

What is Medicare?
Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-State Renal Disease (ESRD) (permanent kidney failure requiring dialysis or kidney transplant).

With Medicare, you can choose how you get your health and prescription drug coverage.

Original Medicare

• Run by the Federal Governemnt.
• Provides your Part A and Part B coverage.
• You can join a Medicare Prescription Drug Plan to add drug coverage.
• You can buy a Medigap (Medicare Supplement) policy to help fill the gaps in Part A and Part B coverage.

Medicare Advantage Plans (like HMO or PPO)

• Run by private companies. Approved by Medicare.
• Provides your Part A and Part B coverage but can charge different amounts for certain services.
• If you want drug coverage, you must get it through your plan (in most cases).
• You don't need a Medigap policy.

Other Medicare Health Plans

• Plans that aren't Medicare Advantage Plans but are still part of Medicare.
• Includes Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
• Some plans provide Part A and Part B coverage, and some also provide prescription drug coverage.

There are 4 parts to medicare. Each provides very specific areas of coverage. Click "Part A" to start.

What is Part A (Hospital Coverage)?

Part A helps cover the following:

• Inpatient care in hospitals (includes critical access hospitals and inpatient rehabilitation facilities).
• Inpatient stays in a skilled nursing facility (not custodial or long-term care).
• Hospice care services.
• Home health care services.
• Inpatient care in a Religious Non-Medical Health Care Institution (facility that provides non-medical, non-religious health care items and services to people who need hospital or skilled nursing facility care but for whom that care wouldn't be in agreement with their religous beliefs).

You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. If you aren’t eligible for premium-free Part A, you may be able to buy Part A if you meet the citizenship or residency requirements and you are age 65 or older or you are under age 65, disabled, and your premium-free Part A coverage ended because you returned to work.

What is Part B (Medical Insurance)?

Part B helps cover medically-necessary services like doctors’ services, outpatient care, and other medical services. Part B also covers some preventive services. You can find out if you have Part B by looking at your Medicare card. You pay the Part B premium each month. Most people will pay the standard premium amount, which is $96.40 in 2009. However, your monthly premium will be higher if you meet the following conditions:

• You are single (file an individual tax return), and your yearly modified adjusted gross income in 2007 was more than $85,000.
• You are married (file a joint tax return), and your yearly modified adjusted gross income in 2007 was more than $170,000.

If you don’t sign up for Part B when you are first eligible, your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. If you delay taking Part B because you or your spouse (or a family member, if you are disabled) is working and has group health plan coverage based on current employment, you may not have to pay the higher premium.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA Plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren’t supplemental insurance.

Medicare Advantage Plans include the following:

• Preferred Provider Organization (PPO) Plans
• Health Maintenance Organization (HMO) Plans
• Private Fee-for-Service (PFFS) Plans
• Medical Savings Account (MSA) Plans
• Special Needs Plans (SNP)

Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plan can charge different out-of-pocket costs. These are usually copayments but can also be coinsurance and deductibles.

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (usually for an extra cost). You may need a referral to see specialists. Some Medicare Advantage Plans have provider networks. In some cases this means you can only see doctors who belong to the plan or go to certain hospitals to get covered services (other than for emergency or urgently needed care or medically-necessary dialysis).

In some plans, if you see a doctor or other provider who doesn’t contract or participate with the plan, your services may not be covered at all, or your costs will likely be higher.

Medicare Prescription Drug Coverage (Part D)

Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage.

There are two ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”

Even if you don’t take a lot of prescription drugs now, you should still consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage, you will likely pay a late enrollment penalty (higher premiums) if you choose to join later. Note: Discount cards, doctor samples, free clinics, drug discount websites, and manufacturer’s pharmacy assistance programs aren’t prescription drug coverage and aren’t creditable coverage. Click "Next Steps" to continue.

Now that you have a good understanding of how Medicare works, it's time to look at what your next steps are.

Medicare plans are as unique as the individual. With more than 450 options to choose from, it is important to prioritize your needs FIRST. This will help us find the plan is right for your unique situation.

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