Let Georgia Health Insurance help you find a Medicare Advantage or Part D Plan
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Complete Plan Comparisons
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Important Facts:
■You must have Part A and Part B. ■ You pay the private insurance company a monthly premium for your Medigap policy in addition to your monthly Part B premium that you pay to Medicare. Contact the company to find out how to pay your premium. ■ A Medigap policy only covers one person. Spouses must buy separate policies. ■ You can’t have prescription drug coverage in both your Medigap policy and a Medicare drug plan. See page 109. ■ It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap premium costs. When to Buy: ■The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. ■ If you delay enrolling in Part B because you have group health coverage based on your (or your spouse’s) current employment, your Medigap Open Enrollment Period won’t start until you sign up for Part B. ■ Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65. Can I Make Changes to My Coverage After December 7? Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave that plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment request. During this period, you can’t: ■ Switch from Original Medicare to a Medicare Advantage Plan. ■ Switch from one Medicare Advantage Plan to another. ■ Switch from one Medicare Prescription Drug Plan to another. ■ Join, switch, or drop a Medicare Medical Savings Account Plan. |
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Health Maintenance Organization: (HMO) Plan:
Can I get my health care from any doctor, other health care provider, or hospital? No. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option. Are prescription drugs covered? In most cases, yes. Ask the plan. If you want Medicare drug coverage, you must join an HMO plan that offers prescription drug coverage. Do I need to choose a primary care doctor? In most cases, yes. Do I have to get a referral to see a specialist? In most cases, yes. Certain services, like yearly screening mammograms, don’t require a referral. What else do I need to know about this type of plan? ■ If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan. ■ If you get health care outside the plan’s network, you may have to pay the full cost. ■ It’s important that you follow the plan’s rules, like getting prior approval for a certain service when needed. Preferred Provider Organization (PPO) Plan: Can I get my health care from any doctor, other health care provider, or hospital? In most cases, yes. PPOs have network doctors, other health care providers, and hospitals, but you can also use out-of-network providers for covered services, usually for a higher cost. Are prescription drugs covered? In most cases, yes. Ask the plan. If you want Medicare drug coverage, you must join a PPO plan that offers prescription drug coverage. Do I need to choose a primary care doctor? No. Do I have to get a referral to see a specialist? In most cases, no. What else do I need to know about this type of plan? ■ PPO plans aren’t the same as Original Medicare or Medigap. ■ Medicare PPO plans usually offer more benefits than Original Medicare, but you may have to pay extra for these benefits. When can I Join, Switch, or Drop a Medicare Advantage Plan? ■ When you first become eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. ■ If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of disability and ends 3 months after your 25th month of disability. ■ Between October 15–December 7 anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7. Special Enrollment Periods: In most cases, you must stay enrolled for the calendar year starting the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. Some examples are: ■ You move out of your plan’s service area. ■ You have Medicaid. ■ You qualify for Extra Help. See pages 111–115. ■ You live in an institution (like a nursing home). |