Medicare Information

I'm just turning 65. What are my insurance options?

The Health Care Financing Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans.

Medicare is a Health Insurance Program for people 65 years of age and older, some disabled people under 65 years of age and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

While Medicare provides a solid base of insurance coverage, there are certain services it does not cover. Medicare enrollees must pay the costs that are not covered.

To help you understand the full range of options, we've outlined your insurance choices here:

Original Medicare

Medicare is divided into three parts: Part A, Part B and Part D, which became effective January 1, 2006.

Once you meet the Medicare eligibility requirements, you must enroll in Part A. You may elect to also enroll in Parts B and D. While there is an additional fee attached to electing Parts B and D, it is usually the better choice for most individuals.

You should apply for enrollment three months before the month you turn 65. You can elect to enroll at a later time, but you will face higher premiums.

Supplemental Coverage

This is optional additional coverage to supplement what you get from Original Medicare.

Commonly called "MediGap," this additional coverage is provided by private insurance companies to help pay for expenses not covered by Medicare.

Your choice is one of 10 standard policies, labeled Plan A through Plan J (see chart for details).

Individuals who do not elect Medicare and Supplemental Coverage at the time they turn 65 (also known as the open enrollment period) are subject to significantly higher premiums as well as the possibility of denial due to pre-existing medical conditions if they choose to enroll at a later time.

Medicare HMO

Medicare HMO is an alternative to the two-step process of Medicare and Supplemental Coverage.

Companies selling Medicare HMO plans contract directly with Medicare and are required to cover all services normally approved under the original Medicare program.

Medicare HMO companies may then cover additional services if they choose such as vision, dental, or preventive care. Medicare HMO premiums are usually lower than the cost of a MediGap plan.

Members enrolled in a Medicare HMO are required to get their care from doctors and hospitals that participate in the HMO's network of providers. Additionally, members must get a referral from their family doctor in order to receive non-emergency care from a specialist or hospital.

Understanding Your Options

It is important to understand the key differences between using Original Medicare supplemented with additional coverage and using a Managed Care Plan such as an HMO.

Your most important decision may be choosing from the options above. There are a number of good resources available to you – such as your local Area Agency on Aging – to help you understand how these options apply to your personal situation.

The managed care department at Evangelical Community Hospital can also refer you to other resources to help you make an informed decision. Just call the Evangelical Managed Care Department at (570) 522-2748.