Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You pay for services as you get them. When you get services, you'll pay a deductible at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).
Medicare Advantage is Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These "bundled" plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn't cover — like vision, hearing, and dental services. Medicare Advantage Plans have yearly contracts with Medicare and must follow Medicare's coverage rules. The plan must notify you about any changes before the start of the next enrollment year.
Swipe your Benefits Mastercard® Prepaid Card (Flex Card) at an approved retail location when paying for approved items or wellness services. When prompted, select " credit." If you select "debit," the transaction will be declined. Your Flex Card will use the funds from the appropriate spending allowance to pay for the approved items or services.
The funds will be taken directly from your program allowance. Your card cannot be used at an ATM or for cash back when making a purchase.
Note: Transactions must be made at the store's main checkout, not the pharmacy counter.
The late enrollment penalty (also called the "LEP" or "penalty") is an amount that may be permanently added to a person's monthly premium for Medicare drug coverage (Part D).
A person may owe a late enrollment penalty if, after their Initial Enrollment Period (when they first get Medicare Part A and/or Part B), they go without Part D or other creditable prescription drug coverage for any period of 63 or more days in a row.
Generally, the Part D late enrollment penalty is added to the person's monthly premium for as long as they have Medicare drug coverage, even if the person changes their Medicare plan. This also means that if a person joins a plan that has a $0 monthly premium, they'll still pay a monthly late enrollment penalty.
The late enrollment penalty amount changes each year. The cost of the late enrollment penalty depends on how long the person went without Part D or other creditable prescription drug coverage.
You can only join, switch, or drop a Medicare Advantage Plan during these enrollment periods:
Initial Enrollment Period (IEP)
When you first become eligible for Medicare, you can join a Medicare Advantage Plan during your Initial Enrollment Period. For many, this is the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Annual Enrollment Period (AEP)
Between October 15 and December 7 each year, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1 the following year (as long as the plan gets your request by December 7).
Medicare Advantage Open Enrollment Period (OEP)
Between January 1 and March 31 of each year, you can make these changes:
During the Medicare Advantage Open Enrollment Period, if you have Original Medicare you can't:
You can only make one change during the Medicare Advantage Open Enrollment Period, and any change you make will be effective the first of the month after the plan gets your request. If you're returning to Original Medicare and joining a separate Medicare drug plan, you don't need to contact your Medicare Advantage Plan to disenroll. The disenrollment will happen automatically when you join the drug plan.
Special Enrollment Period (SEP)
In most cases, if you join a Medicare Advantage Plan, you must keep it for the calendar year starting the date your coverage begins. However, in certain situations, like if you move or you lose other insurance coverage, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period.
You may also qualify for a Special Enrollment Period to sign up for Medicare (and join a Medicare Advantage Plan) if you miss an enrollment period because of certain exceptional circumstances, like if you're impacted by a natural disaster or an emergency. Visit Medicare.gov or check with your plan for more information.
Select Health Medicare offers different types of Medicare Advantage plans.
HMO
An HMO Plan is a type of Medicare Advantage Plan that generally provides healthcare coverage exclusively from doctors, other healthcare providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or temporary out-of-area dialysis). A network is a group of doctors, hospitals, and medical facilities that contract with a plan to provide services. Most HMOs also require you to get a referral from your primary care doctor for specialist care, so that your care is coordinated.
PPO
A Preferred Provider Organization (PPO) Plan is a Medicare Advantage Plan that has a network of doctors, specialists, hospitals, and other healthcare providers you can use, but you can also use out-of-network providers for covered services, usually for a higher cost, if the provider agrees to treat you and hasn't opted out of Medicare (for Medicare Part A and Part B items and services).
You're always covered for emergency and urgent care. Before you get services from an out-of-network provider, you may want to ask for an organization's determination of coverage from your plan to ensure that the services are medically necessary and that your plan covers them.
SNP
Special Needs Plans provide benefits and services to people with specific diseases, certain healthcare needs, or who also have Medicaid coverage. SNPs tailor their benefits, provider choices, and what drugs they cover to best meet the specific needs of the groups they serve.
Select Health Medicare offers a Dual Eligible SNP (or D-SNP) in some states. This plan is for those who are eligible for both Medicare and Medicaid. D-SNPs also contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits.
SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B services that all Medicare Advantage Plans cover. However, SNPs might also cover extra services tailored to the special groups they serve. For example, if you have a severe or chronic condition, like cancer or chronic heart failure, and you require a hospital stay, an SNP may cover extra days in the hospital.
To join a Medicare Advantage Plan, you must:
What if I have a pre-existing condition?
You can join a Medicare Advantage Plan even if you have a pre-existing condition.
What if I have End-Stage Renal Disease (ESRD)?
You can join a Medicare Advantage Plan even if you have ESRD. In many Medicare Advantage Plans, you can only use health care providers who are in the plan's network and service area. Before you join, you may want to check with your providers and the plan you're considering to make sure the providers you currently use (like your dialysis facility or kidney doctor), or want to use in the future (like a transplant specialist), are in the plan's network. If you're already in a Medicare Advantage Plan, check with your providers to make sure they'll still be part of the new plan's network. Read the plan materials or contact the plan you're considering for more information.
What if I have other coverage?
Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage for yourself, your spouse, and your dependents and you may not be able to get it back. In other cases, if you join a Medicare Advantage Plan, you may still be able to use your employer or union coverage along with the Medicare Advantage Plan you join. Your employer or union may also offer a Medicare Advantage retiree health plan that they sponsor.