Frequently Asked Questions

Q. What is the Affordable Care Act?

A. Medicare and the NEW Health Law (The Affordable Care Act): The Affordable Care Act is the health insurance reform legislation that was passed by Congress and signed into law by President Obama on March 23, 2010. For more information about The Affordable Care Act, visit www.medicare.gov, you can also call 1-800-MEDICARE (1-800-633-4227), TTY users should call: 1-877-486-2048, 24 hours a day, seven days a week. You can also contact your State Health Insurance Assistance Program (SHIP). In Florida, the State Health Insurance Assistance Program is called SHINE. The toll free number is 1-800-963-5337, TTY users should call 1-850-414-2001, Monday through Friday, 8 a.m. to 5 p.m.. You can also write to: 4040 Esplanade Way, Suite 325, Tallahassee, FL 32399-7000.

Q. What is Original Medicare?

A. Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people less than 65 years of age. You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits (if you have 10 years of creditable employment) – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services.

The premium you pay for Part B is usually deducted from your Social Security benefits. Medicare pays for many health care services and supplies, but it doesn't cover all of your health care costs. For example, you pay a deductible for each hospital stay and coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.

Q. What is Medicare Advantage?

A. Medicare Advantage is the new name for Medicare + Choice plans. This type of health plan is an alternative to Original Medicare and was created by the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003. Some examples of Medicare Advantage plans are:

• Medicare Health Maintenance Organization plans (HMO)
• Medicare Preferred Provider Organization plans (PPO)
• Medicare Private Fee-for-Service plans (PFFS)

CarePlus Medicare Advantage HMO plans feature fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care. Starting in 2012, all CarePlus Medicare Advantage HMO benefit plans will include prescription drug coverage.

Q. What is a Medicare Advantage HMO?

A. An HMO features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in co-insurance when you use in-network doctors, a drug benefit plan and wellness or fitness programs. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

Q. What is the Medicare Part D drug benefit?

A. As of January 1, 2006, anyone entitled to Medicare Part A and enrolled in Medicare Part B, regardless of income, was eligible to enroll in a prescription drug benefit. This benefit was designed to help Medicare consumers handle the rising cost of drugs and give them easier access to prescription medications.

Q. What questions should I consider when choosing a Medicare health plan?

A. Before you select a plan, carefully consider the following questions:

• Do you already have a doctor you like?
• Are you choosing a new doctor?
• Is freedom to choose doctors and hospitals very important to you?
• Do you need a Prescription Drug Plan?
• Do you have health problems today or old problems that may recur?
• What drugs are covered by the plan's formulary?
• Does your doctor feel comfortable with the plan's guidelines for your treatment?

Q. What is a Prescription Drug Plan (PDP)?

A. A PDP is a private Prescription Drug Plan that offers coverage for prescription medications. This plan can be used with "Original" Medicare or a Medigap plan.

A Part D eligible individual may not be enrolled in more than one PDP at the same time. A Part D eligible individual may not be simultaneously enrolled in a PDP and a Medicare Advantage (MA) plan except for a MA Private Fee-For-Service (PFFS) plan that does not offer the Part D benefit, a Medicare Savings Account (MSA), or unless otherwise provided under CMS waiver authority.

At this time, CarePlus Health Plans, Inc. does not offer a stand-alone PDP.

If you're considering a PDP, please keep the following in mind:

• Optional plan. A PDP is an option – not a requirement. However, if you don't join a PDP when you become eligible, you'll have to pay a higher premium if you join later.
• Monthly premium. PDPs have a monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans, including CarePlus, have coverage for prescription drugs as a benefit without an additional monthly premium.
• No overlap with Medicare Advantage. If you're enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that's the case, choosing the PDP isn't necessary – in fact, getting the PDP would require you to drop your Medicare Advantage coverage.

Q. What are the basic parts of the Medicare program now?

A. There are four parts to Medicare.

Medicare Part A is hospital insurance – including hospital stays, rehabilitative nursing facilities, home health care, and hospice. Most people don't have to pay a premium for Part A because it was prepaid through their payroll tax while they were working.

Part B is medical insurance – including doctors' services and outpatient care. There is a monthly premium for Part B. If you don't sign up for Part B when you first become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you didn't enroll.

Medicare Part C is the Medicare Advantage program. With this option, you can opt to have your Medicare Parts A and B provided by a private company like CarePlus.

Medicare Part D is prescription drug coverage. In one way, Part D is like Part B: If you don't join at age 65, you may have to pay a penalty when you do join.

Q. I'm confused about the enrollment dates. Can you help me understand them?

A. Here's a quick review of the key dates and deadlines for the upcoming enrollment dates:

• October 1 – October 14, 2011: 2011 Benefit and premium information is available from all organizations, so you can shop, compare and be ready to enroll by October 15, 2011.
• October 15 – December 7, 2011 (Annual Election Period, AEP): Medicare beneficiaries can enroll in a 2012 Medicare health benefits plan, such as a Medicare Advantage HMO plan, Original Medicare, or a stand-alone Prescription Drug Plan (PDP).
• January 1 – February 14, 2012 (Medicare Advantage Disenrollment Period, MADP): Beneficiaries that have a Medicare Advantage plan can return to Original Medicare, but are no longer able to switch Medicare Advantage plans during this time. Medicare beneficiaries may enroll in a stand-alone drug plan (PDP), which may cause the termination of their Medicare Advantage plan. Changes must be made by February 14, 2012.

Q. Where can I get more information about Medicare Advantage HMO plans and my Social Security benefits?

A. For more information you can call, or go online, for answers about your coverage:

Centers for Medicare & Medicaid Services (CMS)

1-800-633-4227

TTY 1-877-486-2048

24 hours a day; seven days a week

www.medicare.gov

Florida Medicaid

Medicaid is the state and federal partnership that provides health coverage for selected categories of people with low incomes. Medicaid is different in every state. For information about Medicaid, call your State Health Insurance Assistance Program (SHINE) at: 1-800-963-5337, TTY users should call 1-850-414-2001. Monday through Friday, 8 a.m. to 5 p.m. The address is: 4040 Esplanade Way, Suite 325, Tallahassee, FL 32399-7000.

Social Security Administration (SSA)

1-800-772-1213

TTY 1-800-325-0778

Monday through Friday, 7 a.m. to 7 p.m.

www.ssa.gov

U.S. Railroad Retirement Board

1-877-772-5772

TTY 312-751-4701

24 hours a day, 7 days a week

www.rrb.gov

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