New health plan options for Medicare beneficiaries have been established through the 1997 Balanced Budget Act. These new health plan options, known as Medicare Health Plan Choices, represent the largest expansion to the Medicare program since its inception in 1965.
Beginning January 1999, Medicare began offering you more health insurance choices. This means that you will be able to:
- Continue to receive your health care through the Original Medicare Plan.
- Join a Health Maintenance Organization (HMO).
- Join any of a number of different types of health care plans:
- HMO with a Point of Service (POS) option
- Preferred Provider Organization (PPO)
- Provider Sponsored Organization (PSO)
- Medical Savings Account (MSA) Plan
- Private Fee-for-Service Plan
- Private Contracts
- Religious Fraternal Benefits Society (RFB) Plans
No change is necessary if you are happy with your current health care option.
If you are currently enrolled in the Original Medicare Plan or a Medicare HMO and you want to switch to one of the new Medicare Health Plans, you must have both hospital (Part A) and medical (Part B) insurance and not have End Stage Renal Disease. You also must live in the service area of the health plan choice.
Eligibility:
You can join a Medicare Health Care Plan as long as you:
- Have Medicare Part A and B
- Don't have End Stage Renal (Kidney) Disease
- Live in the geographical area the plan services
- Fill out and sign all election forms and give the plan information needed to join
- Agree to follow the plan's rules once the rules are explained to you
- Don't belong to more than one plan at a time
Plan Differences:
While plans may differ according to legal, structural, licensing, and solvency, you are probably concerned with the scope of services provided, access to providers, and "out-of-pocket" costs. Given the subtle differences among plans, you should make every effort to read a plan's membership materials carefully to learn your rights and the type and extent of coverage it provides. The final selection of a plan is your decision.
Risks to Changing:
While it is easy to change health care plans, you need to be advised that switching does carry with it certain risks. For example, suppose you disenroll from the Original Medicare Plan with a Supplemental Insurance policy, join a Managed Care Plan, and drop your Medigap policy. Shortly thereafter, you decide to re-enroll in the Original Medicare Plan. When you attempt to buy another Medigap policy, you may find that certain costly restrictions apply. There are protections in place should this occur. You may contact your State Health Insurance Advisory Program for Assistance, or the New York State Department of Insurance.
Before joining a plan or changing from your current plan, carefully read all plan membership materials and know what benefits you will receive. To enroll in or switch to a new plan, one of the first steps you must take is to find out what plans are available in your area.
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The Medicare Choices Helpline:
You can find out which plans are available in your area by calling the Medicare Choices Helpline,
1-800-MEDICAR(E)
1-800-633-4227
TTY/TDD 1-877-486-2048
Call the Helpline for:
- General information and printed materials on the Medicare Health Plan options in your area in English or Spanish
- Printed materials in English for quality or satisfaction information on managed care plans in your state
- Disenrollment form and information to disenroll from a Medicare + Choice organization (health maintenance organization or managed care plan)
- The 2001 Medicare & You handbook available in print, audio cassette or braille versions. Print and audio cassette versions are available in English or Spanish
The Helpline is available to all 50 states and Washington D.C. TTY/TDD service is available nationally for the hearing impaired (1-877-486-2048).
You can reach an English or Spanish-speaking operator 24 hours a day (except federal holidays). Pre-recorded answers to frequently asked questions are available 24 hours a day in English or Spanish.
Other Sources for Medicare Information:
- Your local State Health Insurance Information Program through the Office for the Aging
- Social Security Administration (1-800-772-1213) to apply for Medicare
- State Health Insurance Assistance Programs for free unbiased health insurance counseling and assistance
- Your Medicare carrier or intermediary for specific Medicare claim information, Medicare coverage issues, or to report suspected fraud and abuse
- Internet access at: www.medicare.gov or www.cms.hhs.gov. (Click the "Medicare plans" banner below, for tools that let you compare health plans.)
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