Q.

What is Medicare? How does it work?

A. 

Medicare is a federal health care program, managed by the Centers for Medicare & Medicaid Services (CMS), which provides health insurance to retired individuals regardless of medical condition and to certain people with disabilities. Original Medicare is a fee-for-service plan with two components, Medicare Part A and Medicare Part B.

Medicare Part A provides coverage for hospital bills (inpatient hospital care, hospice care, and home health care). This is financed by payroll taxes, with no premium to beneficiaries who have at least 40 quarters of Medicare-covered employment. The beneficiary pays a $1,068 deductible for hospital stays up to 60 days, with additional copays required for each stay longer than 60 days.

Medicare Part B provides coverage for doctor bills (physician care as an inpatient at a hospital, at a doctor's office, or as an outpatient at a hospital or other health care facility) laboratory tests, physical therapy, and ambulance service. The 2009 Medicare Part B beneficiary premium is $96.40 per month. Medicare Part B has a $135 annual deductible, with 20% coinsurance after deductible is met.
  

Q.

What is a Medicare Advantage Plan?

A. 

Medicare Advantage is the name for a few different types of plans that contract with the federal government. Medicare Advantage plans include Medicare Managed Care Plan (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee-for-Service plan (PFFS) and Medicare Cost and other specialty plans. Essentially, these plans reduce out-of-pocket expenses and provide greater coverage than traditional Medicare alone, providing all the benefits of Medicare Parts A and B, plus additional benefits. The beneficiary continues to pay the Medicare Part B premium as well as any additional premium charged by the Medicare Advantage plan. Asuris TruAdvantage is a PPO with a Medicare Advantage contract.
 

Q.

Who is eligible?

A. 

Potential members need to be at least 65 years old or qualified as disabled by Medicare.  They must have Medicare Parts A and B, live within the plan’s service area, and not have end-stage renal disease [ESRD].
 

Q.

Why should you consider an Asuris TruAdvantage plan as compared to an HMO plan or a Medicare Supplement?

A. 

There are three types of health care plans that help protect you from unexpected costs. 

Health Maintenance Organizations (HMOs) are managed care plans that require the member to use only contracted doctors and hospitals and typically referrals are required to see specialists.

Preferred Provider Organizations (PPOs) also have a contracted network of providers, but members can still see any provider that accepts Medicare patients and receive coverage.  The plan pays more if you receive your care and services in-network.

• HMOs and PPOs offer increased benefits over Original Medicare such as physicals and vision care.  HMOs and PPOs roll Original Medicare benefits and supplemental benefits into one plan that replaces Medicare.

Medicare Supplement plans are secondary policies to Medicare.  They do not have a network of providers and usually cost more per month than HMOs and PPOs.  Most Medicare Supplement plans typically do not offer coverage for physicals or vision care.

Medicare Supplement (Medigap) plans help reduce your out-of-pocket medical expenses for unexpected medical costs associated with Medicare deductibles and coinsurance. This coverage can include the Part A and Part B deductibles and coinsurance, the skilled nursing facility coinsurance, as well as other benefits.

• There are twelve standardized Medigap plans, labeled “A” through “L” each with different sets of benefits and premiums.  Plan A has basic supplemental benefits, Plan J the most comprehensive.  All plans include basic benefits but not all insurance companies offer all Supplement plans.
   

Q.

What providers can I see?

A. 

With an Asuris TruAdvantage plan, members are free to see any contracted provider accepting Medicare patients.  Our provider networks offer many qualified providers to choose from.  When a member chooses to see a provider that is not in our network, the member’s share of the costs will be greater.  Members are encouraged to see in-network providers to receive the best benefit from the plan and lower out-of-pocket costs.  The opportunity for members to choose who provides their care is one of the advantages of our Asuris TruAdvantage plans.
 

Q.

How do you find in-network providers?

A. 

Your sales packets and member welcome packets will include a provider directory. Provider directories are also available online in the Find a Provider section.
 

Q.

What dental coverage is included?

A. 

With Asuris TruAdvantage, Asuris TruAdvantage + Rx Classic and Asuris TruAdvantage + Rx Enhanced, a member can go to any dentist and is covered up to $500 annually for routine preventive dental services such as cleanings, x-rays and exams. This benefit is not available with Asuris TruAdvantage + Rx Core. See the (496k PDF) Summary of Benefits for limitations.
 

Q.

What vision coverage is included?

A. 

With Asuris TruAdvantage, Asuris TruAdvantage + Rx Classic and Asuris TruAdvantage + Rx Enhanced, members are eligible for routine vision exams once every two years for in-network services.  There is a $10 copay per visit for utilizing in-network services. Vision hardware is covered up to $100 every two years. This coverage is not available with Asuris TruAdvantage + Rx Core.

Q.

What about hearing services?

A. 

For Medicare-covered hearing exams (diagnostic hearing exams), there is a $10 copay per visit for with Asuris TruAdvantage, Asuris TruAdvantage + Rx Classic and Asuris TruAdvantage + Rx Enhanced for in-network services. A $25 copay applies to Asuris TruAdvantage + Rx Core for in-network services.
 

Q.

Are prescription drugs covered?

A. 

Yes, if you choose Asuris TruAdvantage + Rx Core, Asuris TruAdvantage + Rx Classic and Asuris TruAdvantage + Rx Enhanced.  You pay a share of your prescription medication costs (copays or coinsurance), and your plan pays a share.
 

Q.

What if I don’t want prescription drug coverage?

A. 

If you don’t want or need prescription drug coverage, you can choose just the Asuris TruAdvantage plan.  Please note that if you were Medicare eligible, do not have creditable prescription drug coverage and didn’t choose a Medicare Part D plan by May 15, 2006, there is a 1% premium penalty for every month you could have enrolled but didn’t.
 

Q.

What other services does Asuris TruAdvantage provide?

A. 

Access to discount programs such as vision care services, hearing care services, discounts at fitness clubs and discounts on prescription medications.
 

Q.

Are members locked into Asuris TruAdvantage for a specific length of time?

A. 

Yes, most people will be required to stay with the same plan for one year.  For people currently on Medicare, the Annual Election Period (AEP) is November 15 to December 31. During this time, enroll in an Asuris TruAdvantage plan and your coverage will start January 1. If you are already on a Medicare Advantage PPO, HMO or PFFS plan you can still switch to an Asuris TruAdvantage plan, or cancel your plan, during this time.

If you are currently on Original Medicare or a Medicare Advantage plan you also have an Open Enrollment Period (OEP) from January 1 to March 31.  During this time you can switch Medicare Advantage plans or cancel your plan and go back to Original Medicare Part A and B.

Once you enroll in our plan it is effective until January 1 of the following year.  Your next opportunity to change or enroll comes on November 15 each year for a January 1 effective date.
 

Q.

What help is available for people with limited income?

A. 

Individuals on limited income, applying for prescription drug plans (such as Asuris TruAdvantage + Rx), may qualify for reduced premiums and/or copayments.
(70k PDF) I Have Limited Income What Should I Do?