Your Medicare Options

• Inpatient care in hospitals (includes inpatient rehabilitation facilities)
• Inpatient stays in a skilled nursing facility (not custodial or long term care)
• Hospice care services
• Home health care services

There is usually not a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. If you aren’t eligible for premium-free Part A, you may review the Medicare and You guide provided by Medicare to learn more about your options.

There are various deductibles associated with Part A. The deductible amounts usually change from year to year. You may get more information about Part A deductibles by reviewing the Medicare and You guide at Medicare.gov.

Part B is your Medical Insurance and helps cover medically-necessary services like doctors’ services, outpatient care, and other medical services. Part B also covers some preventive services.

Part B does have a monthly premium. Most people will pay the standard premium amount, which is $96.40 in 2009. You also pay a Part B deductible each year before Medicare starts to pay its share. In 2009, the deductible amount is $135.

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 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 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 Medicare

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.

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