MedicareMadeClear.com is an educational service provided by UnitedHealthcare®
. Its purpose is to inform and empower consumers to make Medicare decisions based on their specific needs. The information on the site is based on public, nonprofit, government and academic sources and is not intended to influence readers in any way. You can get information about specific plans offered in your area by UnitedHealthcare®
and other private insurance companies by calling the companies directly, by viewing their commercial web sites or by using the Plan Finder at Medicare.gov
You can get more information about these plans from Medicare through either the Medicare telephone helpline or the Medicare website. The Medicare website includes an online Medicare Plan Finder tool. Your State Health Insurance Assistance Program (SHIP) can help you learn more about these plans, too.
You can also learn more about a specific plan by calling customer service at the private company that offers it. You can find customer service numbers for companies in your area on the Medicare website, or you can get the numbers by calling the Medicare telephone helpline or your local SHIP office.
When you call the insurance company’s customer service number, ask for a “Summary of Benefits” for a Medicare Advantage plan. If you’re interested in a Medicare supplement insurance plan, ask for an “Outline of Coverage.” These documents summarize plan benefits, what's paid for under the plan and what you would pay for coverage.
It’s important that you understand your choices.
First, find out whether you can keep any of the coverage you have now when you retire. Also find out whether your current coverage can be combined with Original Medicare Parts A and B and what your costs might be if you combined them. If you can keep some of the coverage you have now, you may have more choices than the standard ones.
If you have retiree coverage available to you through your current employer, union or other source (like VA Benefits or TRICARE), talk to your benefits administrator, insurer or plan before making any changes to your coverage. If you drop your current coverage, you may not be able to get it back.
You’ll need to talk with someone who’s familiar with the details of the plan you have now. If your coverage is a benefit from an employer or a union, talk to the human resources or benefits administrator. If you have individual insurance that you’ve been paying for yourself, call your insurance company’s customer service number.
Medicare won’t cover you until you reach age 65, even if your spouse is already receiving benefits. When your spouse enrolls in Medicare, you’ll need to find other health insurance coverage until you turn 65.
Find out whether your spouse’s current health coverage can cover you after your spouse retires. For example, you may be eligible for COBRA coverage for up to 36 months. And look for health insurance offered by groups you belong to, like a social or professional organization or an alumni association. You may also be able to purchase individual health insurance policies.
If you qualify, you can receive financial help with Medicare premiums and other costs, like deductibles and copays. Contact your local Social Security Administration office or state Medical Assistance (Medicaid) program to find out if you qualify for help.
Call the plan’s customer service number and ask whether your doctors participate in the plan. You can get customer service numbers by calling the Medicare Helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also call your doctor’s office. Ask for the person who handles the doctor's insurance billing, and then ask whether the doctor accepts the plan.
Your Medicare Advantage plan will notify you if your doctor leaves the plan’s network. You’ll be able to choose a new doctor. Generally, you aren’t able to change plans in this situation until the next Medicare Open Enrollment begins unless you qualify for an exception.
You can keep your Medicare supplement insurance plan after you enroll in a Medicare Advantage plan. However, you'll have to keep paying the Medicare supplement insurance plan’s premium, and you won’t be able to use the plan to pay any cost sharing (like deductibles, copays or coinsurance) under the Medicare Advantage plan. Your Medicare supplement insurance plan can help you only with deductibles and other costs when you use Original Medicare.
If you drop your Medicare supplement insurance plan, you can apply for another only if you are receiving your benefits through Original Medicare at the time. You cannot buy new Medicare supplement insurance if you have a Medicare Advantage plan unless you are changing to Original Medicare by the time the Medicare supplement coverage begins.
When you have Original Medicare Parts A and B, you can usually apply for a new Medicare supplement insurance plan whenever you like. However, you may be charged a higher premium or refused coverage entirely. There are only certain situations in which you have the right to buy a plan regardless of your health. Your State Health Insurance Assistance Program (SHIP) can help you decide what to do with your Medicare supplement insurance plan in this situation.
Medicare’s guidelines for prescription drug plans say that certain types of drugs may be excluded from all prescription drug plans.
These types of drugs are excluded:
- Drugs used for anorexia, weight loss or weight gain
- Drugs used to promote fertility
- Drugs used for cosmetic purposes or hair growth
- Drugs used for the symptomatic relief of cough and colds
- Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
- Non-prescription drugs
- Inpatient drugs
- Barbiturates (sleeping pills)
- Benzodiazepines (central nervous system depressants)
- Erectile dysfunction drugs
Some prescription drug plans do cover some of these types of drugs. These plans are called “enhanced plans.”
In addition, a drug cannot be covered under a prescription drug plan if payment for that drug is available under Original Medicare. An example is a drug that is administered in a hospital or physician's office, such as a chemotherapy drug.
Each prescription drug plan may have additional specific exclusions from its formulary—the list of specific drugs it covers.
That depends on where you’re moving. If you’re moving within the area your current plan serves (its service area), you can keep the plan. If you’re moving out of your plan’s service area, you’ll need to find out what your plan options are in your new area. They may include choosing a new Medicare Advantage plan from the plans available in the area you’re moving to, or returning to Original Medicare (with an optional standalone prescription drug plan and Medicare supplement insurance plan).
You can find out whether your new home is in your current plan’s service area by calling your plan’s customer service number.
Before Medicare or a health plan will disclose personal health information to someone other than the Medicare beneficiary, the beneficiary has to let Medicare or the health plan know in writing that it’s OK to disclose his or her personal health information. A beneficiary can do this by completing a Medicare Authorization to Disclose Personal Health Information form.
Medicare’s Authorization to Disclose Personal Health Information Formis available online. Talk to the health plan’s customer service department to determine their process for setting up the authorization.
It’s important to decide who should have the legal right to make medical and treatment decisions if you or your loved one are unable to make them. These decisions are generally called "advance directives."
In most cases, advance directives include the following types of documents:
- A health care proxy, which may also be called a “Health Care or Medical Power of Attorney” or a “Durable Power of Attorney for Health Care.” This names a specific person who will make the health care decisions for you if you're unable to make them yourself.
- A living will. Living wills give directions about the kind of health care you want when you aren't able to make a decision. Living wills state which medical treatments you would accept or refuse if your life was threatened and you weren't able to express these wishes.
- After-death wishes. These may include decisions such as organ and tissue donation. If there are advance directives, make sure you know where these documents are kept. Give copies to the appropriate doctors, anyone named in the documents and perhaps other concerned family members or friends.
Contact your local office on aging, your state health department or an attorney to learn more about advance directives.