Medicare Plans

A type of health insurance plan with which you can only go to the doctors and hospitals that have agreements with this plan. In case of emergency you can go to any health care service, even if it has no agreement with HMO plans. Your primary care doctor should give a referral before you see a specialist.

Types of Medicare Advantage Plans:

Also called Medigap and sold by private companies that can help pay some of the health care costs like copayments, coinsurance, and deductibles that Original Medicare doesn't cover.

Health Maintenance Organization (HMO) Plans

Proffered Provider Organization (PPO) Plans

Private Fee-for-Service (PFFS) Plans

Medicare Advantage Plan which allows you to pay less if you use hospitals, doctors that belong to the network in that regional area. You pay additional cost if you use doctors and hospitals outside of the network.

Medicare Advantage Plan that allows you to go to any Medicare - approved doctor or hospital that agrees and accepts to treat you under the plan's payment terms. This is fee-for-service plan that decides how much you must pay for services.

Special Needs Plans (SNPs) Plans

Medicare Special Needs Plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.

HMO Point-of-Service (HMO-POS) Plans

These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

MEDICARE SUPPLEMENT

What do Medicare Supplement Plans cover?

• Besides covering the healthcare costs like copayment, coinsurance and deductibles which are not covered by Original Medicare, some Medicare Supplement Plans (MS) also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.

• If you have Original Medicare and you get Medicare Supplement Plan (Medigap), Medicare will pay its share of the Medicare-approved amount for covered health care costs, after that your MS (Medigap) plan pays its share.

Important Things to Know about Medicare Supplement Plans (Medigap):

• You must have Medicare Part A and Medicare Part B.

• A monthly premium paid to the private insurance company for Medicare Supplement Plan (Medigap) is separate from the monthly Part B premium that you pay to Medicare.

• If you have a Medicare Advantage Plan, you can apply for a Medicare Supplement Plan (Medigap), but make sure you can leave the Medicare Advantage Plan before your Medigap begins.

• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

• You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

• Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

• Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

• It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

The following Insurance plans are not Medicare Supplement Plans (Medigap):

• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)

• Medicaid

• Medicare Prescription Drug Plans

• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)

• TRICARE

• Veterans' benefits

• Long-term care insurance policies

PRESCRIPTION DRUG PLANS

Also called Part D and sometimes called "PDPs" Are plans that 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.

Also called Part D and sometimes called "PDPs"

Coverage Gap

Medicare drug plans may have a "coverage gap", which is sometimes called the "donut hole". This means that after you and your drug plan have spent a certain amount of money for covered drugs, you may have to pay more for your drugs (until you reach the out-of-pocket threshold)

Catastrophic Coverage

Means a small coinsurance amount paid by you or a co-payment for the rest of the year for covered drugs. You automatically get this coverage once you reach Out of Pocket Threshold (your spending on prescription drugs reaches a certain amount).

Brand - name Drug

A brand-name drug is a medication researched and developed by a pharmaceutical company and then patented to protect against other companies making copies and selling the drug.

Generic Drugs

According to the Food and Drug Administration (FDA) generic drug is a prescription drug with the same active - ingredients as a brand drug with less cost.

Extra Help

Qualifies you for the full low-income subsidy for Medicare prescription drug coverage and you pay $0 deductible, no more than $8,35 (brand) or $3,35 (generic) for your prescription with full extra help.

Elderly Pharmaceutical Insurance (EPIC) Program

• The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 320,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.

• EPIC provides secondary coverage for Medicare Part D and EPIC-covered drugs purchased after any Medicare Part D deductible is met. EPIC also covers approved Part D-excluded drugs once a member is enrolled in Part D.

• EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible.

• EPIC has two plans based on income. The Fee Plan is for members with income up to $20,000 if single or $26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if single or $26,001 to $100,000 if married.

• It is easy to join the program. Just complete the application and mail or fax it to EPIC. No documentation is required. EPIC verifies information with the Social Security Administration and the New York State Department of Taxation and Finance.
• More information about Elderly Pharmaceutical Insurance ( EPIC) Program you can find here

• Also you can download application here

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