However, if you have a Medigap plan, youll be covered for certain out-of-pocket expenses. Sign up and well send you Nerdy articles about the money topics that matter most to you along with other ways to help you get more from your money. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. It is advisable to request a date-stamped copy of the application for your records. Get organized with paperless EOBs. This influences which products we write about and where and how the product appears on a page. UnitedHealthcare/AARP Medicare Advantage plans are the most popular plans nationwide, with 28% of Medicare Advantage enrollment. Half of All Eligible Medicare Beneficiaries Are Now Enrolled in Private Medicare Advantage Plans. Enrollment in the TRAIL MAPD health plan provides you with Medicare Advantage coverage as well as Medicare Part D coverage. If you take prescription drugs, some plans may offer lower out-of-pocket costs than others. The switch to Medicare Advantage plans is not related in any way to the rollout of the ACA. You also have the option to purchase a Medigap plan, which will cover certain deductibles, copays and coinsurance for treatment under Medicare Part A and Part B. What Does Medically Necessary Mean for Medicare Coverage? Welcome to SERS. Any deadlines that advertisers may be referring to likely refer to Medicare enrollment for people not yet enrolled in individual Medicare plans and do not apply to the vast majority of retirees. If you fail to provide a copy of the Medicare card with your MBI number to the Medicare COB unit or your Retirement system, your TRAIL MAPD and State medical insurance will be waived for the dependent(s) with the missing documentation and waived for the entire household if the member's documentation is not provided. It helps with the cost of health care, but doesnt cover all medical expenses or the cost of most long-term care. If a plan decides to stop participating in Medicare, youll have to join another Medicare health plan or return to Original Medicare. Visit our website: https://starleadsmedia.com/medicare-leads/. If your residential or mailing address changes, you must notify both your retirement system and the Social Security Administration in writing as quickly as possible. Once you pass your initial. Lets say you get cancer, and you want to go to [Memorial] Sloan Kettering [Cancer Center]. Although these plans are required to have an out-of-pocket cap on spending, it can be as high as. Find Medicare.gov on facebook (link opens in a new tab), Follow Medicare.gov on Twitter (link opens in a new tab), Find Medicare.gov on YouTube (link opens in a new tab), A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. On Medicare Advantage, you have less freedom to choose your medical providers because you often must use providers within your plan's network. Because Medicare has no out-of-pocket spending cap for Parts A and B, experts recommend buying a Medigap plan if you opt for Original Medicare. These changes impact retirees enrolled in the Total Retiree Advantage Illinois (TRAIL) who are also Medicare Eligible. Following a proposal process, the State of Illinois has selected Aetna Medicare Advantage Prescription Drug (MAPD) PPO Plan as the new medical and prescription drug plan beginning January 1, 2023. If you are covered by an employer health plan, either from your own or your spouses current employment, you can delay enrolling in Medicare Parts A and B. If you take prescription drugs, some plans may offer lower out-of-pocket costs than others. Inspire is the most effective alternative to CPAP." - Bruce Corser, MD - Sleep Management Institute While a Medicare Advantage plan replaces original Medicare, you are still responsible for Medicare Part B premiums, which are either paid directly to Medicare or deducted from Social Security benefits. You can purchase a Medigap plan during the six-month period that starts once youve turned 65 and have enrolled in Medicare Part B. She shares a home in Los Angeles with a husband, a daughter and a co-dependent golden retriever. Most Medicare Advantage plans also include. Medicare Advantage plans are required to cover all services covered by Original Medicare. Part D premium: Varies by plan; average is $31.50 per month in 2023. To obtain additional coverage you may enroll in a Part D prescription drug plan for prescription drug coverage, re-enroll in the State-Sponsored TRAIL plan throughout the plan year with coverage effective the first of the month following your enrollment request, or enroll during your next annual TRAIL MAPD Enrollment Period. If you have a serious condition, the out-of-pocket costs can add up. Ask a nurse 24/7 This staggering collective value alone places a target on pension systems from a myriad of individuals and groups Before You Call: Answers to Frequently Asked Questions, Power of Attorney (POA) and Guardianships, Why Its Important to Pay Your Part B Premium, Any age with end-stage renal disease requiring dialysis or a kidney transplant. Part B premium: Starts at $164.90 per month in 2023. When evaluating offers, please review the financial institutions Terms and Conditions. What should I know about Medicare Advantage Plans? And while our site doesnt feature every company or financial product available on the market, were proud that the guidance we offer, the information we provide and the tools we create are objective, independent, straightforward and free. Original Medicare has no cap on out-of-pocket costs, meaning if you need significant care, you could be on the hook for thousands of dollars in deductibles, copays and coinsurance. MORE: What Does Medically Necessary Mean for Medicare Coverage? When you enroll in a Medicare Advantage Prescription Drug (MAPD) plan, you are no longer in Original Medicare, but still have the same covered services and the same rights and protections as people with Original Medicare. With SERS coverage, your premium with SERS will be reduced. Use your EOB to see your progress through the Medicare Part D coverage phases, including the coverage gap. This must be completed by November 30, 2022. is medical insurance, covering things like doctors visits, preventive services and durable medical equipment. In addition to her extensive health plan experience, Debra worked at the Centers for Medicare & Medicaid Services, or CMS, in the Seattle area, where she oversaw national and local Medicare Advantage plans. This information may be different than what you see when you visit a financial institution, service provider or specific products site. You can reach them at (888) 292-2091. You can reach them at (888) 292-2091. If theyre not in your network, you cant go there.. The 2023 TRAIL. In this case, Aetna is the private company who will take over administration. Non-Medicare enrollees also can change their health plan. Theres also Medicare Supplement Insurance, or Medigap, which is additional insurance you can buy from private health insurance companies to cover certain deductibles, copays and coinsurance that Medicare doesnt cover. In 2022, 45% of Medicare beneficiaries have a Medicare Advantage plan, according to data from The Chartis Group. If youre allowed to go out-of-network, youll likely need preauthorization and your care will usually be more expensive. Medicare-eligible retirees, annuitants, and survivors who want to continue medical, prescription drug, and vision coverage through the State, are required to enroll in the TRAIL MAPD health plan if they and their covered dependents are all enrolled in Medicare Parts A and B. Its important to understand that if you have a serious health issue, you may not have access to the specialists you prefer if theyre out-of-network. This will replace the existing plans, most commonly the HMO Plans through UnitedHealthcare, Health Alliance, or Humana. If there are Medicare Advantage plans in your area with a wide network of providers, including a few top-notch hospitals, youll have more options when it comes to your health care decisions. UnitedHealthcare Medicare Advantage plans. Most Medicare Advantage Plans include Health Care Services staff details upcoming changes to SERS health care program in 2023. The changes to retiree health care plans only apply to SERS and SURS annuitants and their covered dependents who are enrolled in Medicare Parts A&B and reside in the United States. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. Medicare Advantage plans work like traditional health insurance plans you may have gotten through an employer, in which theres a network of providers and you must stay within the network to have your care covered. Once you have a Medicare Advantage plan, you can switch plans during Medicare open enrollment in the fall or Medicare Advantage open enrollment from Jan. 1 to March 31 each year[0]Centers for Medicare & Medicaid Services. to find the plan in your area. Do not sell or share my personal information. Its just about being properly educated on how things function., Kate Ashford is a certified senior advisor (CSA) and personal finance writer at NerdWallet specializing in Medicare and retirement topics. You can enroll in a Medicare Advantage plan only during your initial enrollment period (when you first become eligible for Medicare) or during the open enrollment period from Oct. 15 to Dec. 7. Due to your Medicare-eligibility, you cannot keep your current State of Illinois health plan. You may have to get approval from your Medicare Advantage plan to have certain tests or procedures, which can delay care. Under both the HMO and PPO plans, drug coverage costs the same, both for copays and deductibles, as the current HMO and PPO plans respectively. When you become eligible for Medicare, you have a choice to make on how to receive your coverage: Original Medicare or a Medicare Advantage Plan, For more information, watch the video Your Medicare Coverage Choices.. Medicare Advantage, also known as Medicare Part C, is a bundled alternative to Original Medicare. Youre also still responsible for your Medicare Part B premiums. Read more, Kate Ashford is a certified senior advisor (CSA) and personal finance writer at NerdWallet specializing in Medicare and retirement topics. You must be enrolled in Medicare Parts A and B before you can buy a Medicare Advantage plan. Part A (Hospital Insurance) Darlynda Bogle, Assistant Deputy Commissioner. The TRAIL Program provides comprehensive medical and prescription drug coverage through the Aetna MAPD PPO plan, which is a Medicare-approved plan that combines the different parts of Medicare into one plan.