Frequently Asked Questions

Answers to questions you may have about Original Medicare and the new Medicare options

With the changes in Medicare, you may be confused about your options and which plans are best for you. Here’s an outline of the upcoming changes to Medicare and the new Medicare Advantage plans that will help you make sense of your choices.

 

Q. What questions should I consider when choosing a Medicare health plan?

A. Before you select a plan, carefully consider the following questions:

  • Do you already have a doctor you like?
  • Are you choosing a new doctor?
  • Is freedom to choose doctors and hospitals very important to you?
  • Do you need a prescription drug plan?
  • Do you have health problems today or old problems that may recur?
  • What drugs are covered by the plan’s formulary?
  • Does your doctor feel comfortable with the plan’s guidelines for your treatment?
 

Q. What is Original Medicare?

A. Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services.  The premium you pay for Part B is deducted from your Social Security benefits.

Medicare pays for many health care services and supplies, but it doesn’t cover all of your health care costs. For example, you pay a deductible for each hospital stay and coinsurance anytime you use the services of a physician or surgeon.  Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage plan instead.

 

Q. What is Medicare Advantage?

A. Medicare Advantage is the new name for Medicare + Choice plans. This type of health plan is an alternative to Original Medicare and was created by the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003. Some examples of Medicare Advantage plans are:

  • Medicare Health Maintenance Organization plans (HMO)

  • Medicare Preferred Provider Organization plans (PPO)

  • Medicare Private Fee-for-Service plans (PFFS)

Medicare Advantage plans feature prescription drug benefits, fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care.

 

Q. What is a Medicare Advantage HMO?

A. An HMO is an alternative to Original Medicare and features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in co-insurance when you use doctors, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

 

Q. What is a Medicare Advantage PPO?

A. With a Medicare Advantage PPO, you can see any doctor you want. However, if you use a doctor who participates in the network, you get a better benefit and lower copayment than if you visit a non-network doctor. Plus, referrals aren’t needed and you don’t have to see a primary care doctor first. In addition to prescription drug benefits, Medicare Advantage PPOs may offer additional benefits such as dental, vision, and nutritional supplements. If you select a Medicare Advantage PPO, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

 

Q. What are Humana’s regional PPO plans?

A. In 2006, regional Medicare Advantage PPO plans will be available to consumers eligible for Medicare. Check out the key features and advantages of these plans:

Features What this means for you
Larger networks, usually covering more than one state More choices of providers in a wider geographic area
Limit on copayments After your copayments total a specific amount, you don't need to pay any more copayments
 

Q. What is a Medicare Advantage PFFS plan?

A. With a Medicare Advantage PFFS plan, you have the freedom to select any doctor, hospital, or health care provider who accepts Humana’s payment terms and conditions, without worrying about referrals or a list of doctors who participate in the plan’s network. PFFS plans feature limits on out-of-pocket expenses, coverage for emergency and urgent care, and in some cases, a prescription drug benefit. If you select a PFFS plan, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

 

Q. What is a Medicare Supplement plan?

A. A Medicare Supplement insurance plan helps cover the “gaps” in coverage that are left unpaid after Original Medicare pays its portion of your health care expenses. For this reason, these plans are often referred to as Medigap plans. Unlike a Medicare Advantage plan, which replaces your Original Medicare benefits, a Medicare Supplement plan is purchased in addition to your Original Medicare benefits.

Medicare Supplement policies are standardized into twelve plans – labeled “A” through “L,” each with its own set of benefits. Plan A covers the most basic benefits. These basic benefits are also covered in each of the remaining Medicare Supplement plans – B through L. Plans B through L provide additional coverage beyond the basics, with Plan J offering the most benefits.

Medicare Supplement policies are sold by private insurance companies. While the costs of these policies may vary, individual insurance companies must provide the same standardized benefits as outlined by law. In order to purchase a policy, in general you must be enrolled in Medicare Part A and Part B. In addition to paying the monthly Medicare Part B premium to Medicare, you will have to pay a premium to the insurance company providing your coverage.

 

Q. What is the new Medicare Part D drug benefit?

A. Medicare is contracting with insurance companies, including Humana, to offer prescription drug plans (PDPs). The PDPs replace the drug discount cards. If you’re considering a PDP, please keep the following in mind:

  • Optional plan. A PDP is an option – not a requirement. However, if you don’t join a PDP when you become eligible, you’ll have to pay a higher premium if you join later.

  • Monthly premium. PDPs have a monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans, including Humana’s, have a PDP included as a benefit without an additional monthly premium.

  • No overlap with Medicare Advantage. If you’re enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that’s the case, choosing the PDP isn’t necessary – in fact, getting the PDP would require you to drop your Medicare Advantage coverage.

  • Benefits and costs. PDP plan benefits vary, but companies offering these plans are required to offer the minimum benefits listed below. Humana’s PDP benefits are equal to, or better than, these required minimums.

 

Q. What are the minimum benefits for a PDP?

A. With a PDP, you pay the first $250 of prescription costs – the annual PDP deductible. After the deductible, your costs are:

  • 25 percent of prescription drug costs from $250 to $2,250 (that’s $500)

  • 100 percent of prescription drug costs from $2,251 until your out-of-pocket costs reach $3,600

  • 5 percent of prescription drug costs, or a small copayment, for the rest of the year
Here is some additional Medicare information to consider if you’re interested in a PDP:

  • Financial assistance. If you have a limited income, you may be eligible to apply for financial help.

  • PDP enrollment. If you’re a current Medicare beneficiary and want PDP coverage, enrolling in the plan by May 15, 2006 gave you the lowest premium. Enrollment is automatic for consumers who are “Qualified Medicare Beneficiaries” – those on a limited income who receive assistance with their Medicare premiums and copayments.
 

Q. What will happen to the Medicare drug discount cards?

A. If you signed up for a Medicare drug discount card, you can continue to use the remainder of your credit until May 15, 2006, or until you join a drug plan, whichever comes first.

 

Q. Can you help me compare Original Medicare to the Medicare Advantage plans?

A. This side-by-side comparison helps explain the differences between Original Medicare and the Medicare Advantage plans that private insurers offer.

  Original Medicare (managed by the government) Medicare Advantage (sponsored by the government and offered by private insurers, including Humana)
Benefits

Part A - Inpatient hospital

Part B - Doctors' services

 Inpatient hospital and provider services, plus additional benefits such as vision and dental
Premium

Part A - $0 for people who have worked 40+ quarters

Part B - $88.50 per month

 Monthly premium varies by plan and geographic area. Some plans have no additional monthly premium.
Types of plans Fee-for-service Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS), and specialty plans
Is additional - coverage necessary? Yes - additional policy from private insurance company, at added cost No - not needed because benefits are extensive
Billing procedures Provider bills Medicare first, insurance second Simplified administration - in most cases, provider bills only the Medicare Advantage insurance company
 

Q. How can I get extra help with Medicare costs?

A.If you have limited income and resources, you may qualify for certain programs that help with medical expenses. These services include Medicaid, Medicare Savings Programs, and other federal, state, and local programs. To find out about these programs and how to qualify, contact your State Medical Assistance office.

The government is also providing extra help with prescription drug costs. People with limited income and resources can take advantage of reduced premiums and out-of-pocket costs. Limited income means an annual income of less than $14,355 for a single person or $19,245 for a married couple that lives together. You also need to have limited resources to qualify - this includes savings and stocks but not your home or car.

During the summer of 2005, the government sent letters to people who automatically qualify for extra help with prescription drug costs. If you didn't receive a letter, but you think you might meet the requirements, you can apply by sending a form to the Social Security Administration.

 

Q. What should I expect once I become a Humana member?

A. You will receive your ID card 7-10 days from the time of enrollment. In addition, you will receive your Evidence of Coverage (EOC) in the mail.

Your “Evidence of Coverage” document is your insurance policy with Humana. It explains:

  • Your plan benefits, coverage, rights, and responsibilities as a Humana member

  • Humana’s rights and responsibilities as your insurer

The “Evidence of Coverage” is an important document. Please review it and keep it with your insurance records. We don’t expect you to read it all! But you’ll at least want to look over the Table of Contents, where you’ll see a list of all the topics the document covers.

Humana sends you the “Evidence of Coverage” booklet to comply with the federal government’s requirement that we disclose the details of your Humana plan. We fully support the disclosure of such information – because you have a right to know all about the benefits, provisions, and limitations of your coverage. The “Evidence of Coverage” is a necessary and valuable document designed to inform and guide you.

Because the “Evidence of Coverage” contains so many details, it’s a rather lengthy document. But we’ve tried to keep our printing and mailing costs to a minimum. Rest assured, the costs of producing and mailing your “Evidence of Coverage” will not affect the amount of your premium! 

You might think the “Evidence of Coverage” contains more information than you’ll ever need. But you might be surprised. Depending on your health or financial situation, you could have questions that never occurred to you before. For example, you might want to find out if you qualify for extra help with prescription drug costs. Or you might want to know how your prescription drug plan works if you go to a hospital or skilled nursing facility.

When you have questions like these, look them up in your “Evidence of Coverage.” It’s a reference book, like a dictionary or an encyclopedia – but it’s devoted only to details of your Humana plan and your relationship with Humana. Your “Evidence of Coverage” can be a valuable resource, so please keep it in your files at home, where you can find it when you need it.

If you’d like to contact Humana, you can call our Customer Service department – but be prepared to wait! With the recent changes to Medicare, we’re experiencing extremely high call volumes. So you’ll save time by checking your “Evidence of Coverage” for the information you need.

 

Q. Where can I get more information about Medicare Advantage plans and my Social Security benefits?

A. For more Medicare information you can call – or go online – for answers about your coverage.

  • Centers for Medicare and Medicaid Services
    7500 Security Blvd.
    Baltimore, MD 21244-1850
    1-800-633-4227
    TTY 1-877-486-2048
    24 hours a day; seven days a week
    www.medicare.gov

  • Social Security Administration
    Office of Public Inquires
    Windsor Park Blvd.
    6401 Security Blvd.
    Baltimore, MD 21235
    1-800-325-0778
    TTY 1-800-325-0778
    7 a.m. – 7 p.m.
    www.ssa.gov

  • Railroad Retirement Board
    Chicago District Office
    844 N. Rush Street
    Ninth Floor
    Chicago, IL 60611-2092
    1-800-808-0772
    TTY 312-751-4701
    24 hours a day, 7 days a week
    www.rrb.gov