skip to main content
Main Site Navigation
Top of main content

Learn the ABCs and Ds of Medicare coverage

Learn the ABCs and Ds of Medicare coverage
Do you wish Medicare better fit your needs and budget? Until December 7, you can switch to a Medicare Advantage plan that’s made for you. It’s the annual enrollment period for those who are 65 or older or are disabled. Now is the time to review your Medicare options. Medicare has four mix-and-match parts so you can find the coverage that’s right for you.
Original Medicare
The federal government manages Original Medicare, made up of Part A and Part B, and usually requires you to pay a cost for every health care service you get.
Medicare Part A, also known as hospital insurance, covers:
  • Inpatient hospital stays
  • Skilled nursing facility stays
  • Hospice care
  • Nursing home care
  • Home health care
“Original Medicare doesn’t have a provider network, so you can see any doctor in the U.S. who accepts Medicare,” Jonathan Davis, Health Alliance community liaison, said. “You typically pay a deductible, copays or coinsurance for services. Most people pay a monthly premium for Part B, but you usually don’t pay a premium for Part A if you or your spouse paid Medicare taxes while working.”

Medicare Part B, also called medical insurance, covers certain care from doctors, outpatient care, medical supplies and preventive care, which includes:
  • Services like flu shots
  • Care through clinical trials
  • Ambulances
  • Durable medical equipment
  • Mental health care
  • Limited prescription drugsTwo elderly couples hiking through the woods
“Another important thing to know about Original Medicare is there is no maximum out-of-pocket protection on what you spend,” Davis said. “That’s why it’s important to look at options for additional coverage like Medicare Advantage or Medicare Supplement.”
Medicare Supplement
  • Managed by private companies
  • Adds to Original Medicare coverage to pay for more of your healthcare costs
  • Covers Parts A and B
  • No provider network
Medicare Advantage
Simplete Medicare Advantage plans, or Part C plans, replace Original Medicare. Many plans also include prescription drug coverage to combine Part A, Part B and Part D into one easy package.
“Our plans have networks of trusted doctors who offer lower prices to members and Medicare requires plans to have enough doctors to treat their members. These doctors work closely with the plan to coordinate your care. Some plans allow you to go out-of-network, but you typically save money staying in-network,” Davis said.
Depending on your plan, you may pay a copay or coinsurance for services. You pay a monthly premium to your private insurance company unless you’re on a $0 premium plan. You also continue to pay your Part B premium. Most people don’t have to pay for Part A. When you select a Medicare Advantage plan, it also comes with great extras.
Medicare Part D adds prescription drug coverage. You can buy Part D from insurance companies to go with your Original Medicare coverage or your Medicare Supplement coverage, or you can choose a Medicare Advantage plan that includes Part D prescription drug coverage.
“Simplete plans are lead by physicians, it’s pharmacists and doctors who decide which drugs to cover based on quality, safety, and how well they work. We offer hundreds of low-cost options,” Davis said. “To better serve our members, we’re now offering low cost generics at all our network pharmacies and continuing to stretch your healthcare budget further by reducing your prescription drug costs through convenient mail order services.”
Simplete plans offer competitive prescription drug copays and this year decreased 90-day copay costs for mail order prescriptions.
“It’s the equivalent of buy two months, get one free,” Davis said.
In addition, 2021 Simplete plans:
  • Expanded pharmacy network so we offer a number of low-cost generic drugs at all in-network pharmacies
  • Plans provide virtual health coverage (includes both telemedicine with your primary care provider or a specialist and on demand virtual visits).
  • Eliminated the copay on the Medicare covered eye exam so vision exams are now free for in-network providers
  • All with the same great customer service.
When and How Do I Enroll?
You can enroll in or change Medicare coverage every year during Medicare’s Annual Election Period (AEP). Important dates to note:
Oct. 15 – Dec. 7: Annual Enrollment Period
Dec. 7: Last day to enroll in or change plans if coverage is to begin Jan. 1. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period (SEP).
Jan. 1: Coverage begins.
Jan. 1- Mar. 31: Open Enrollment Period
During this timeframe, you have the opportunity to switch to Original Medicare.
Health Alliance is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance depends on contract renewal.
Out-of-network/non-contracted providers are under no obligation to treat Simplete members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

Categories: Staying Healthy

Tags: Health Alliance, insurance, medicare, medicare news