Understanding Medicare basics
Learn the different parts of Medicare and get to know the various options you have to choose from. (Video, 5:15)
Open video transcriptUnderstanding Medicare
Tips to understand Medicare and prepare for enrollment
Medicare coverage is made up of several “parts” – Original Medicare (Parts A and B), Medicare Advantage (Part C) and Medicare prescription drug plans (Part D) – designed to fit specific needs. We’ll help you understand how Medicare works, avoid potential penalties and compare plans.
Medicare Parts Explained
Plan types at a glance
Medicare Advantage Plans
With a Medicare Advantage plan, you'll have access to a network or doctors and hospitals as well benefits and services that go above and beyond such a dental, hearing, vision and over-the-counter benefits. HAP Medicare Advantage health insurance plans start at $0 per month*.
Health maintenance organization (HMO) plans
HMOs are typically more affordable than PPOs. HMO members get their care through their primary care physician, or PCP. If you need to see a specialist, all you have to do is make an appointment. Your doctor will handle the rest.
HMO point of service (HMO-POS) plans
Very similar to the HMO above with the added flexibility to see doctors outside your network, if needed. This type of plan is good for members who want extra coverage when traveling outside the HAP network. Members still get lower premiums and regularly managed care through their PCP.
Preferred provider organization (PPO) plans
PPOs offer more flexibility than HMOs but you’ll pay a little more for care. You don’t need to have a PCP (but you should pick one), and you can seek care in, or outside of, the network.
Medicare Supplement (Medigap)
Medigap plans, also known as Medicare supplement plans, are offered by private companies such as Alliance Health and Life Insurance Company® as a a way to help pay some of the health care costs Original Medicare doesn’t cover like copays, coinsurance and deductibles. It only supplements your Original Medicare benefits. You’ll still need to have Medicare Parts A and B.
HAP offers Alliance Medicare Supplement Plans A, C, D, F, G and N.
When to enroll in Medicare
There are a few times when you are allowed to sign up for a Medicare Plan.
If you don’t yet have a Medicare plan, you can enroll in one if:
-
You’re turning 65
-
You experience a disability that qualifies you for Medicare
If you already have a Medicare plan, you can enroll in a different plan:
-
During the Annual Enrollment Period, which is every year from Oct. 15 to Dec. 7
-
If you have a Medicare Advantage plan, you can make one change during the Medicare Advantage Open Enrollment Period which happens from Jan. 1 to Mar. 31.
-
If you experience a life event that qualifies you for a special enrollment period, or SEP.
Understanding your out-of-pocket costs
When weighing health plan costs, you need to look beyond your premium. As a health plan member, you’ll need to pay your part of the costs associated with your care through:
- Copays
- Coinsurance
- Deductibles
Copay
This is a set amount you pay each time you visit your doctor, get health care services, medications or health care supplies. The amount depends on the type of covered service. Often, copays don’t count toward your deductible. You’ll still pay copays after you’ve met your deductible, until you reach your out-of-pocket limit. In some cases, your deductible must be met before copays start.
Deductible
The amount you owe for covered health care or prescription drugs before your plan starts to pay for them. There are individual deductible amounts and family deductible amounts. If you go out-of-network for care, your deductible will be much higher. Your deductible resets each benefit period, which is most often a calendar year.
Coinsurance
The percentage of charges for certain covered health care that you pay after your deductible has been met.
Out-of-pocket limit
The most you’ll have to pay out-of-pocket during your benefit period, which is usually a calendar year.
As you explore your Medicare choices, you may run across unfamiliar words or phrases. Check out our Medicare glossary to understand what common Medicare terms mean.
Still have questions?
You can join us at one of our free Medicare seminars to get the latest information and answers to your questions.
Send us an email, or give us a call and speak with a licensed HAP Medicare sales representative.
