October 2001
Your Medicare Choices

Beginning with the Basics

Does the very word Medicare make your head spin? You're not alone. Medicare options are changing so fast, and so often, it's no wonder people are confused—and upset. Whether you (or your parents!) have just reached Medicare age (65 years), or are having to change Medicare managed care coverage (again!), here are some explanations to help you choose.

What is traditional Medicare?
It's the government's insurance program for Social Security recipients aged 65 or older (and some disabled people under age 65). With traditional Medicare, you may chose any Medicare-certified physicians, specialists, and hospital without restrictions. Eligibility for traditional Medicare is not income-based—it is available to all who qualify for Social Security. It covers most—but not all—of your healthcare needs—hospitalization, physicians, nurses, and other basic services.

Traditional Medicare covers many—but not all—of your medical costs for certain services. Medicare Part A is free, and you can be enrolled at age 65. Part A covers fully the first 60 days of hospital and nursing home care (after the deductible has been met), and part of days 61-150. Medicare Part B, which covers certain physician and outpatient services, is optional, and you pay a monthly premium (about $50) for this coverage.

If you don't have a Medigap policy, you'll also pay a yearly deductible (in 2000, this was $792 for Part A and $100 for Part B) and co-payments (partial payments of the cost of care you receive for some services under Parts A and B). The chart below shows the services Parts A and B help to pay for.

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What is Medigap?
Medigap policies are supplements, not substitutes, for traditional Medicare. There are ten standard Medigap plans to choose from. Offered by private insurance companies rather than the government, Medigap helps pay for medical services not covered by traditional Medicare—such as deductibles, co-insurance, and the cost of some care after Medicare runs out. You pay premiums that vary depending on the extent of the services covered. Depending on which plan you choose, Medigap may also help pay for prescription drugs, annual physical exams, screenings, and more.

Medigap insurance does not cover long-term care. If you want this type of coverage, you should investigate purchasing a separate long-term care policy.

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What does Medicare Part A help pay for? Yes No
Hospitalization X  
Nursing home care X  
Home health care X  
Some hospice care X  
What does Medicare Part B help pay for?    
Doctors and skilled nursing care X  
Medical equipment such as wheelchairs X  
Some preventative services X  
Some outpatient and home health services X  
Prescription medications   X
Eye care, glasses or contact lenses   X
Dental care; Hearing aids   X
Annual physical exams   X
What do Medicare HMOs help pay for?    
Medicare Parts A and B X  
Prescription medications X  
Eye care, glasses or contact lenses X  
Dental care; Hearing aids X  
Annual physical exams X  

FOR MORE HELP: This quick overview does not explain all of the available Medicare and Medigap insurance plans and benefits. If you would like to receive the CHOICES material about Medicare supplement options, or if you would like more detailed information on Medicare packages, call Bridgeport Hospital at 888-357-2396. If you would like other information about Medicare, Medigap, HMOs, and Long Term Care insurance, or about special arrangements for those with limited financial resources, call the Southwestern Connecticut Agency on Aging—CHOICES program, 800-994-9422. Top

What is Medicare managed care?
Medicare managed care is offered by an HMO (health maintenance organization). The government originally allowed insurance companies to offer Medicare managed care plans in an attempt to reduce the high cost of medical care.

To accomplish this cost-cutting goal, Medicare HMOs emphasize prevention and wellness. They also encourage members to choose doctors and hospitals from within the plan's network. If you prefer a physician or hospital that is not within the network, your plan may refuse to pay for your care. Your primary care physician coordinates most of your care. With some Medicare HMOs, care from specialists (such as cardiologists) may not be fully covered unless you are referred by your primary care physician—even if you chose your specialist from within your plan's network.

In order to join a Medicare HMO you must be enrolled in Medicare parts A and B. Medicare managed care plans are also allowed (though not required) to offer full or partial coverage of some extra benefits.

Medicare HMOs may limit