Health Alliance Medicare | smart simple.

Great question, one that takes some time to answer. Please visit the What Is Medicare? page at the beginning of our Research & Learn section to find out more. You can also learn about Medicare Parts A, B, C and D and a host of other topics there.

Original Medicare is a health plan managed by the federal government that’s available to people age 65 and older and some others with disabilities. It helps pay for medical care, but doesn’t cover all medical expenses and doesn’t cover prescription drug costs.

More about Original Medicare

Medicare Advantage plans are Part C plans that replace Original Medicare and are offered by private companies like Health Alliance that have a contract with Medicare. These plans generally offer extra benefits and lower copayments than Original Medicare. They can also provide prescription drug coverage.

More about Medicare Advantage plans

Medicare Supplement plans are offered by private companies like Health Alliance to help cover medical expenses Original Medicare doesn’t cover. You must have Original Medicare to purchase a Medicare Supplement plan. With a Medicare Supplement plan, you can see any doctor and go to any hospital that accepts Medicare patients, but these plans don’t include prescription drug coverage.

More about Medicare Supplement plans

Both types of plans are offered by private companies like Health Alliance. Medicare Advantage plans are Part C plans provided as an alternative to Original Medicare. Medicare Supplement plans are not Part C plans. They are plans you can purchase in addition to Original Medicare to help cover medical costs Original Medicare doesn’t cover.

Medicare Advantage plans cover what Original Medicare covers and more. Plus, many plans include drug coverage. Medicare Supplement plans usually cover fewer medical services, and they don’t include drug coverage.

When you purchase a Medicare Advantage plan, a group of doctors and hospitals (called a provider network) you can use comes with it. With some plans, you can use any doctor and hospital, but you’ll pay less if you use those in the provider network. With a Medicare Supplement plan, you can see any doctor and go to any hospital that accepts Medicare patients.

There are only certain times during the year when you can enroll in a Medicare Advantage plan. See When You Can Enroll for more information.

The main difference is that with an HMO plan coverage is limited to care from certain doctors and hospitals, unless it’s an emergency. These doctors and hospitals are referred to as plan providers, and they’re listed in the Medicare HMO Provider Directory. With an HMO plan, you’ll also need to choose a personal doctor, called a Primary Care Physician (PCP).

With PPO plans you can go to any doctor or hospital, but you’ll pay less if you go to doctors and hospitals in the plan’s network. These are called in-network providers, and they’re listed in the Medicare PPO Provider Directory.

You can get prescription coverage two ways. If you prefer to have one plan for both your medical and drug coverage, you can purchase a Medicare Advantage plan. Health Alliance Medicare Advantage plans HMO 20Rx, PPO 10Rx, and PPO 30Rx include prescription coverage.

If you have Original Medicare or Original Medicare and a Medicare Supplement plan, you can purchase a Stand-Alone Part D plan that just covers prescription drugs.

Generally, the only time you can enroll in a Medicare plan or switch plans is during the annual enrollment period. In 2011, the annual enrollment period is October 15 – December 7.

From January 1 – February 14 of 2012, you can leave your Medicare Advantage plan and go back to Original Medicare. If your plan includes drug coverage, you can leave your plan and go back to Original Medicare and join a Part D plan.

You can’t make plan changes at any other time unless you’re in the initial enrollment period or you meet a special exception. See When You Can Enroll for more information.

To find the right plan, first see what’s available. Learn about each type of plan and think about cost, coverage and convenience. Consider your budget, what you need coverage for and the doctors you want to be able to see.

If you’ve learned about the plans, but still aren’t sure what’s right for you, try Walk Me Through. You’ll answer five (or fewer) simple questions about your preferences, and we’ll show you Health Alliance Medicare plans that match your answers.

More help finding the right plan

This depends on what type of Medicare plan you have.

• With Original Medicare you can go to any doctor or hospital that accepts Medicare and is accepting new Medicare patients.
• With a Medicare Supplement plan, you can also choose any doctor or hospital that accepts Medicare and is accepting new Medicare patients.
• With an HMO plan, you can only go to certain doctors and hospitals that are referred to as plan providers and are listed in the Medicare HMO Provider Search.
• With PPO plans, you can go to any doctor or hospital, but you’ll pay less if you go to doctors and hospitals listed in the Medicare PPO Provider Search.

In-network refers to doctors, hospitals, pharmacies and other health care professionals who have made an agreement with Health Alliance Medicare to provide services to our members. Out-of-network providers have not made this agreement.

With a PPO plan, you pay less when you receive care from providers that are in-network. HMO plan members must use in-network providers, also called plan providers, except in emergency or urgent care situations.

This depends what type of Medicare plan you have. Medicare Supplement plans don’t have a provider network, so you can choose any doctor or hospital that accepts Medicare and is accepting new Medicare patients.

• With an HMO plan, you will pay the entire cost of your routine care if you go to a doctor who’s not listed in the Medicare HMO Provider Directory.
• With PPO plans, you can choose any doctor or hospital, but you’ll pay more if you go to doctors not listed in the Medicare PPO Provider Directory.

Simply go to Find a Plan to get a comparison of Health Alliance Medicare plans available to you.

You can also reference a plan’s Summary of Benefits for a comparison of Original Medicare to a Health Alliance Medicare Advantage plan.

You can reference two documents to see what services a plan covers and doesn’t cover. The plan’s Summary of Benefits lists a summary of covered services. For a complete list of what is and is not covered, see the plan’s Evidence of Coverage.

To find out what drugs are covered, see the Medicare Part D Formulary. Health Alliance Medicare also posts a list of changes to our formulary since the last printed version, which typically comes out October 1 of each year. Please note that to meet the needs of our members, our formulary is an open formulary, which allows coverage for some drugs that are not specifically listed in the formulary.

With any Health Alliance Medicare plan you get emergency coverage worldwide. Members are responsible for a copayment, however, if you are admitted to a hospital or skilled nursing facility, the emergency room copayment is waived.

As a Health Alliance Medicare member, you also receive free global emergency services through Assist America. In case of emergency when you’re more than 100 miles from home, Assist America can help sort out where to go and how to get care. Assist America pays for emergency travel considerations and even pays for a loved one to join you if you’re hospitalized for more than seven days.

Look for the plan’s premium for what you’ll pay per month for coverage. For a complete list of what you’ll pay for services, see the plan’s Evidence of Coverage.

If your plan includes drug coverage, your Evidence of Coverage will also list what you’ll pay for prescription drugs. To find out what you’ll pay for a specific drug, search for the drug in the Medicare Part D Formulary. Covered drugs are listed in the formulary along with what cost group tier they’re in.

You can get prescription coverage two ways. If you prefer to have one plan for both your medical and drug coverage, you can purchase a Medicare Advantage plan. Health Alliance Medicare Advantage plans HMO 20Rx, PPO 10Rx, and PPO 30Rx include prescription coverage.

If you have Original Medicare or Original Medicare and a Medicare Supplement plan, you can purchase a Stand-Alone Part D plan that just covers prescription drugs.

A tier is a cost group that a drug belongs to. Every drug listed in the Medicare Part D Formulary is put into one of five cost groups: Tier 1, Tier 2, Tier 3, Tier 4 or Tier 5 (specialty drug). Generally, the higher the tier, the more you’ll pay for the drug.

To find out if your drugs will be covered by Health Alliance Medicare, search for them in our Medicare Part D Formulary, a list of covered drugs. Please note that to meet the needs of our members, our formulary is an open formulary, which allows coverage for some drugs that are not specifically listed in the formulary.

Generic drugs are just as good as brand-name drugs because the FDA reviews and approves them using the same standards. Plus, a generic drug has the same active ingredients as the brand-name drug, which has years of clinical research and testing behind it.

Search for your drug in our Medicare Part D Formulary to see if it’s covered. The tier that’s listed with your drug indicates what you’ll pay for that drug. You can reference your plan’s Evidence of Coverage to see what you pay for each tier.

In most cases, you must go to an in-network pharmacy for your prescriptions to be covered. Health Alliance Medicare in-network pharmacies are listed in the HMO and PPO Pharmacy Directories.

This depends on your individual needs and budget. If you take prescription drugs, a prescription drug plan can help you pay for these costs. It’s also important to remember that if you’re eligible for a prescription drug plan and you don’t enroll in one, you may have to pay a penalty for enrolling in the plan later, and that penalty increases every month you don’t have prescription coverage.

Again, we’ve got a bit more to tell on this one. Please visit What’s the Coverage Gap? for details.

Medicare is available to people age 65 and older, people younger than 65 with certain disabilities and people of any age with end-stage renal disease (permanent kidney failure).

Remember, there are only certain times during the year when you can enroll. See When You Can Enroll for details.

To be eligible for a Health Alliance Medicare Advantage plan:

• You must have Medicare Part A and Part B and live in the service area.
• You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicare or by another third party.
• You cannot have end-stage renal disease (permanent kidney failure).

With an HMO plan, if you obtain care from out-of-network providers, neither Medicare nor Health Alliance Medicare will be responsible for the costs. If you live in Illinois, have Medicare Parts A and B and are at least 65, you are eligible for a Health Alliance Medicare Supplement plan.

To see what Health Alliance Medicare plans are available where you live, visit Find a Plan.

Remember to see When You Can Enroll for important dates, because you can only enroll at certain times during the year.

We have a whole page called When You Can Enroll to answer that one. Please check it out.

If you’re ready to enroll, simply visit How to Enroll to learn what to do.

If you enroll in Original Medicare, a Medicare Advantage plan or a Part D drug plan during the 2011 annual enrollment period (October 15 to December 7), your coverage begins on January 1, 2012. Generally, you can’t enroll at any other time unless you’re in the initial enrollment period or you meet a special exception. See When You Can Enroll for more information.

If you enroll in a Medicare Supplement plan, your coverage begins on the first day of the month after we receive your enrollment form.