Understanding Medicare and Advantage Plans for NH Residents

Written by April Weismann on 03/21/2017 06:00 AM in Health Insurance.

medicare2 72.jpgMedicare is one of those programs that most people know something about but not enough to make an educated decision on what is truly needed when the time arrives to purchase a plan.  That is when an insurance agent can really help because though it is possible to purchase a plan through the internet, it is your health on the line, so you want to be sure you understand what is and is not covered.  Here is an overview of Medicare and available Medicare Advantage Plans for NH residents.

What NH Residents Need to Understand about Medicare & Advantage Plans

Coverage is divided into parts identifiable by the letters A & B.  Medicare Part A coverage is hospital insurance and Medicare Part B is medical insurance.  Eligibility for coverage typically begins the first day of the month that you turn 65.  It is typical that you are automatically enrolled so you should receive a red, white and blue Medicare card in the mail three months before your 65th birthday.

You may also be eligible if you are younger than 65 and have a disability or ALS.  Please refer to the Medicare.gov website for more specific information. Some people also need to sign up vs. getting automatically enrolled.  This typically happens if you are not collecting social security because you are still working.  If you do need to enroll, there are specific sign-up periods that you do not want to miss to ensure you are covered and avoid having to pay a late enrollment penalty.  When you are first eligible for Medicare, you have a 7-month initial enrollment period unless there are specific circumstances that allow you to enroll in the Special Enrollment Periods.

What does Medicare Part A and Part B cover?

Part A is considered Hospital insurance if you are an inpatient in a hospital.  It may also pay for skilled nursing care, home health care and/or hospice care in certain circumstances.

Part B is considered Medical Insurance for things like doctor services, out-patient hospital care, lab work, imaging, and home care.  Though it covers a wide-range of services, there can be gaps in coverage.  This is where Medicare Advantage and Medicare supplement plans can come in.

What does Medicare Part C cover?

Part C or Medicare Advantage plans are offered by private insurance companies and not the US government like Medicare parts A & B.  To be eligible, you must have Medicare Parts A and B and live in the plan provider's service area and not have end-stage Renal Disease.  In New Hampshire, the popular Medicare Advantage providers include Harvard Pilgrim Health Care, Anthem Blue Cross Blue Shield NH, and United Healthcare NH which are sold through independent insurance agencies as well as directly on-line.  (Please note that there is not a difference in premium between what is purchased on-line vs. with the help of an agent.)  In New Hampshire, Medicare Advantage Plans include benefits that traditional Medicare does not, such as vision, hearing, dental and wellness programs.

What does Medicare Part D Cover? 

Part D is a prescription drug coverage also offered by private insurance companies.  Part D is often included in Part C, a Medicare Advantage Plan, but you will want to be sure given the cost of prescription drugs. Like all health plans, these plans typically include deductibles, co-pays, co-insurances and gaps in coverage.  It is important to understand what your needs are and purchase an appropriate policy to limit your out-of-pocket expenses.  

Can I Enroll or Change my Medicare Advantage Plan Anytime? 

Typically, you can only enroll or change your plan during the Annual Election Period (AEP).  In 2017, AEP starts on October 15th and ends December 7th.  If you are enrolling for the first time or you are making changes to your plan, it will be effective on January 1, 2018.  There are exceptions to the enrollment period, such as a recent move, you are newly eligible for Medicare or the loss of employer coverage.  

Are Medicare Advantage and Medicare Supplement Plans the Same? 

In short - No!  At HPM Insurance, our benefits team gets this question regularly.  When someone is enrolled in a Medicare Advantage plan, the carrier they choose is their sole provider of health insurance.  In other words, they do not use their Medicare card or other benefits.  Medicare Supplement plans (also known as Medi-Gap) plans help with the costs such as co-pays and coinsurance, which Medicare does not cover.  The member will use both Medicare and Medicare Supplement cards to cover medical services.

Will Medicare Coverage Options Change Dramatically due to Changes in the Affordable Care Act? 

In my opinion, no- these plans will not be impacted by changes to the Affordable Care Act.  Medicare has had a stable market and we do not foresee dramatic changes coming in the near future.    

How Do I Know Which Medicare Plan is Best? 

With so many plans and options, the best way to choose a plan is to sit with an experienced insurance professional.  At HPM Insurance, we have team member, Tom Hutton, who has more than 15 years of experience in explaining how Medicare works and finding the best options for his clients. 

The best part?  You can get professional advice on the coverage that is best for you and your budget and pay the same amount as you would if you had purchased a policy on your own through the internet.  To reach Tom, you may call him at 603-673-1201 or email him at Tom@HPMinsurance.com.              

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