Medicare Plan FAQs

Medicare is a federal insurance program for people age 65 and older, younger people with disabilities and those with End Stage Renal Disease.

When you turn 65, you must enroll in Medicare coverage within the seven months surrounding your 65th birthday.

If you do not enroll in coverage during that time but you are eligible for Medicare, you will have to pay a penalty. Learn more about enrollment here.

Medicare Advantage plans combine Original Medicare Parts A and B and offer additional benefits, under one card. Private insurance companies, like CHPW Medicare Advantage, offer these plans.

In addition, they offer extra coverage like dental, vision, hearing and prescription drugs. With an Advantage plan, you have more health care security. You have fixed copay or coinsurance amounts for things like routine doctor’s visits and yearly limits on your out-of-pocket health care costs.

This means once you pay the maximum limit, you pay nothing more.  Original Medicare does not offer these limits. To be eligible for an Advantage Plan, you receive Original Medicare Parts A and B, and continue to pay your Part B premiums.

Generally, anyone who is receiving Original Medicare Parts A and B is eligible for more coverage on an Advantage plan.  There are a few requirements if you wish to enroll in a Medicare Advantage plan. You must:

• Be eligible for Medicare
• Be enrolled in both Medicare Part A and Medicare Part B (if you are enrolled you would have received your red, white, and blue Medicare card)
• Live within the plan’s service area (which is based on the county you live in – not your state of residence)

Original Medicare covers two areas of your health care separately: Part A (hospital insurance) and Part B (medical insurance). Part D is optional and includes prescription drug coverage.

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Part D adds prescription drug coverage.

Medicare Advantage Plans are classified as Part C. These plans combine Original Medicare Parts A and B and offer additional benefits, all under one card. Most advantage plans also include Part D coverage. Advantage plans give you more coverage than Original Medicare alone.

No. Your plan provider will take over some of the administrative processes to implement your Medicare benefits; however, you do not lose your Original Medicare.

You must continue to pay your Medicare Part B premium. An advantage plan enhances your coverage. It works with Original Medicare, but does not replace it.

It’s important to make sure your prescriptions are covered and that the pharmacy you use is in the network. Check whether we cover your prescriptions.

Many Medicare Advantage plans such as CHPW offer extra benefits like hearing, vision, dental, fitness programs, prescription drug coverage, and over-the-counter products.
It’s important to think about your health needs and what you expect from your health coverage.
For instance, the needs of someone with few health concerns will be very different from someone with active health concerns.

Before choosing a plan, you may want to consider the following things:

What costs should I expect for my coverage?

It’s important to know how much you will pay out of your own pocket for things such
as monthly premiums, cost-sharing on health care services, and prescription drugs.

Will I be able to keep my doctors?

You’ll want to know whether the doctor you want to see or the hospital you need
to go to are in the plan’s network. See if your provider is in our network using our Find a Doctor page.

What about drug coverage?

It’s important to make sure your prescriptions are covered and that the pharmacy you
use is in the network. Check whether we cover your prescriptions using our online formulary.

Asking yourself these questions can help make sure that the plan you choose works for your budget and your health care needs.

Browse the available plans we offer. If you still have questions, contact our local Medicare enrollment specialists. They can help answer any questions you have about coverage and help choose a plan based on the coverage you need.

For all other questions or information, please contact our customer service team.

Yes, but only during certain times of the year. During the Open Enrollment Period (from October 15 to December 7) you can switch from one Medicare Advantage Plan to another.

If you want to switch back to Original Medicare, you may do so between January 1 to February 14.

If you have questions about coverage, talk to one of our Medicare experts. They can help you find coverage that fits your health needs.

Maybe. There are certain events that would make you eligible to change plans outside of the Annual Enrollment Period. For example, if you retire after 65 and no longer have coverage from your employer, move to a new service, or are turning 65, you would be able to make changes to your plan.

These life events can happen anytime during the year, so insurance providers can make exceptions. However, if you know you want to change coverage, AEP is most likely the best time to do so.

Most people are eligible to receive Medicare benefits if they meet one of the following requirements:

• are at least 65 years old
• are under 65 years old and living with a disability
• are any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Check the eligibility page to learn more details.

The Annual Enrollment Period (AEP) is a period of time from October 15 to December 7, when Medicare beneficiaries can change their coverage. For example, someone might add or drop coverage, or switch Medicare Plans.

There are many ways to enroll in a new plan or change your coverage.

Our team is available seven days a week from 8:00 a.m. to 8:00 p.m., to answer your questions and help you enroll. Give us a call at 1-800-944-1247 (TTY:711).

If you are thinking of switching plans or adding coverage options, you can schedule a plan review with one of our experts. They can answer any questions you have and help confirm you’re getting the right amount of coverage.

You can enroll online using our online application form.

No. If you are happy with your plan and your health needs haven’t changed, you are not required to make changes during AEP. AEP is for optional changes like enrolling in a plan that better matches your needs. If you’re not sure if you need different coverage or want to explore your plans option, talk to one of our licensed Medicare experts.

Any changes to the plan are described in the Annual Notice of Change (ANOC) which is mailed to you every year. Information can also be found on the plan detail page.

If you are still working past the age of 65, you can delaying enrolling in Medicare. However, you must still have coverage through your employer’s health insurance.  You have the right to delay enrollment until your employment or insurance coverage ends (whichever happens first.) You have the choice to continue coverage on your employer’s plan or sign up for Medicare.