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“НАШЕ ЖИТТЯ”, ЛИСТОПАД 2014 WWW.UNWLA.ORG 17 2015 Medicare & You: Available Medical Coverage for Medicare Eligible Seniors by Orysia Zinycz, CEBS Dear fellow Seniors, Recently, we received the 2015 Medi- care & You booklet from the U.S. Government. Based on my training at LOMA Institute and my CEBS (Certified Employee Benefit Specialist) cer- tification from the University of Pennsylvania, experience, and current information from Medi- care and Medicare Advantage, I would like to call your attention to some important facts about your options for medical coverage. For 2015, your choices are the following: I. Medicare only II. Medicare, Medicare Supplements and /or Part D III. Medicare Complete/Medicare Ad- vantage PPO Plan (PPO: Preferred Provider Organization) IV. Medicare Complete/Medicare Ad- vantage HMO Plan (HMO: Health Maintenance Organization) Important Information: The open enrollment period is from October 15 until December 7, 2014. You may enroll in or change your plans between these dates. Many hospitals now employ emergency room doctors and laboratories who are private con- tractors and are NOT part of the hospital's network. Even if you go to an IN-NETWORK hospital, you may receive huge, OUT-OF- NETWORK bills from the emergency room doctors and/or surgeons as well as from labor- atories. According to the Affordable Care Act (Obamacare), Medigap and Medicare Ad- vantage plans can no longer decline coverage for a pre-existing medical condition. However, there are special provisions for end-stage renal disease. If you joined a Medicare Advantage Plan for the first time, and you are not happy with the plan, you have a special right to switch to orig- inal Medicare and Medigap plans ONLY within twelve months of joining. If you are a former federal or state employee, you might have a better coverage than these plans. Only some Medicare supplemental/Medigap plans cover foreign travel emergency. I. Medicare Part A covers inpatient care in hospital, skilled nursing facility care, hospice, home health care services, but does not cover Part A coinsur- ance. Part B covers health care preventive ser- vices and medically necessary services such as doctor visits, lab tests, surgeries, and supplies (like wheelchairs and walkers). Part B covers 80% of Medicare approved expenses. II. Medicare, Medicare Supplement Insur- ance (Medigap), and Part D Original Medicare pays for many, but not all, health care services and supplies. Available Medicare supplement plans, or Medigap, cover most expenses not covered by Medicare Part A and Part B. Different insurance companies charge different premiums for the same coverage. If you or your spouse is a VFW, check with the VFW for companies which offer special rates to veter- ans. Currently Transamerican Insurance Co. has the lowest premium rates in Florida for veterans. Each person needs a separate policy. Plan D is a prescription drug plan offered by different insurance companies. Both coverage and premiums vary for prescrip- tion drug plans. Consult either with a pharma- cy, which will check your medications and rec- ommend the best coverage, or evaluate online the different plans and premiums available in your state. You also have a right to request ex- ceptions from your plan provider for medica- tions that your plan does not adequately cover. The United States Department of Veteran Af- fairs offers prescription coverage for veterans. REVIEW: Medicare, Medicare Supple- ments, and Medicare Part D You have three choices: (1) Medicare only coverage; (2) Medicare and Medigap; or (3) Medi- care, Medigap, and Medicare Part D. Pros : Under Medicare, premiums, deductibles, and co-payments are set by federal law.
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