Your Medicare Options

Traditional Medicare

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).Traditional Medicare is provided by the federal government and includes Part A and Part B coverage.

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Medicare Advantage

Medicare Advantage plans are part of the Medicare system.

Medicare Advantage plans are health plan options approved by Medicare and offered by private companies. These plans 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 benefits and usually Medicare drug coverage. These plans are not supplemental insurance.

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.

Medicare Advantage plans also may offer extra coverage, such as vision, hearing, and/or health and wellness programs. Most include Medicare prescription drug coverage. With Medicare Advantage plans you sometimes 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 Medicare Advantage 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.

KelseyCare Advantage is a Medicare Advantage HMO plan with a Medicare contract. KelseyCare Advantage is NOT a Medicare supplement, and it does NOT replace original Medicare.

Medicare Prescription Drug Coverage (Part D)

Medicare offers prescription drug coverage (Part D) for everyone with Medicare. But to get those Medicare benefits for drug coverage, you must join a plan offered by an insurance company or other private company approved by Medicare – like KelseyCare Advantage. Plans can vary in cost and drugs covered.

There are two ways to get Medicare prescription drug coverage:

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.

OR

Medicare Advantage Plans (like an HMO or PPO). 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.

If you have limited income and resources, you may qualify for extra help from Medicare paying for prescription drug coverage. You may also be able to get help from the state of Texas.

To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week;
• The Social Security Office at 1-800-772-1213, between 7 am to 7 pm, Monday through Friday. TTY users should call 1-800-325-0778; or
• Your State Medicaid Office. (See Section 6 of this chapter for contact information).

New to Medicare?

Soon, you’ll be eligible for Medicare benefits.

Have you started planning for it?

Step 1

Medicare can be confusing

Before selecting a Medicare plan, it’s important to first understand traditional Medicare. What most people don’t know is that Medicare is comprised of four different parts, and each part works independently from one another. There are also certain eligibility requirements that apply and a range of Medicare benefits to consider.

Step 2

Review all of your options. There are many choices within the Medicare system and each offers a different range of benefits. They include traditional Medicare, Medigap plans, Medicare Advantage plans, retirements plans and prescription drug plans.

Step 3

Make the choice that’s right for you.

Upon learning about Medicare benefits and reviewing all of your options, select the best plan for you. Once you turn 65, you can enroll in the Medicare plan of your choice during a limited period of time.