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Coverage Choices

Coverage Choices

You have important decisions to make when you’re eligible for Medicare. Be confident in choosing coverage that fits your health care and budget needs.


Get to Know Your Coverage Choices

When looking at coverage choices, there’s a lot to consider. You can enroll in Original Medicare Part A (hospital insurance), Original Medicare Part B (medical insurance), or both. Once you enroll in Medicare, there are more coverage choices you can make. Consider a Medicare Advantage plan (Part C), a Medicare prescription drug plan (Part D), or a Medicare Supplement insurance plan (Medigap) to complete your Medicare coverage.

Original Medicare is provided by the federal government and is made up of Part A, which helps pay for hospital stays and inpatient care, and Part B, which helps pay for doctor visits and outpatient care.

You can choose to add one or both of the following to Original Medicare:

  • Medicare Supplement Insurance Plan (offered by private insurers): Helps pay some of the out-of-pocket costs not paid by Original Medicare.
  • Medicare Prescription Drug (Part D) Plan (offered by private insurers): Helps pay for prescription drugs

Or, you can choose a Medicare Advantage plan. These plans are offered by private insurers and:

  • Combines Part A (hospital insurance) and Part B (medical insurance) in one plan.
  • Usually includes prescription drug coverage.
  • Offers additional benefits beyond Original Medicare

Original Medicare Coverage

Original Medicare, provided by the federal government, has two parts: Part A and Part B. Original Medicare Part A helps pay for hospital stays, while Original Medicare Part B helps pay for doctor visits.

The following coverage options are offered by private insurance companies.

Medicare Advantage (Part C) Plans

Medicare Part C is known as Medicare Advantage. Medicare Advantage plans cover and combine Original Medicare Part A and Part B benefits into one plan. Most Medicare Advantage plans also include prescription drug coverage (Part D) and offer additional benefits not covered by Original Medicare, often with no additional premium.

 
  • What's Covered

    • The same benefits as Original Medicare Parts A and B (except hospice care, which is still covered by Original Medicare Part A)
    • Most plans cover prescription drugs
    • Some plans offer additional benefits, like:
      • Eye exams, eyeglasses and corrective lenses
      • Dental exams, cleanings and X-rays
      • Hearing tests and hearing aids
      • Wellness programs and fitness benefit
  • What's Not Covered

    • Hospice care, which is still covered by Original Medicare Part A
    • Benefits vary by plan
 

Special Needs Plans (SNPs)

SNPs are Medicare Advantage plans. If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include prescription drug coverage. Some plans also include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four types of Special Needs Plans:

  • Dual-Eligible Special Needs Plans (D-SNPs) for individuals who have both Medicare and Medicaid
  • Chronic Special Needs Plans (C-SNPs) for individuals living with severe or disabling chronic conditions
  • Institutional Special Needs Plans (I-SNPs) for individuals who live in a skilled nursing facility
  • Institutional-Equivalent Special Needs Plans (IE-SNPs) for individuals who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility

Medicare Prescription (Part D) Plans

Medicare Part D is prescription drug coverage. There are several plan type combinations you can have with a Part D plan:

  • As a standalone Part D plan
  • As part of a Medicare Advantage plan that includes prescription drug coverage
  • In addition to a Medicare Advantage Private Fee-for-Service (PFFS) plan
  • In addition to a Medicare Supplement insurance plan
    • What's Covered

      • Types of drugs most commonly prescribed for people eligible for Medicare (decided by the federal government)
      • Specific brand name and generic drugs on the plan's drug list (formulary)
    • What's Not Covered

      • Drugs not on a plan’s drug list
      • Drugs prescribed for certain cosmetic or non-medically-necessary conditions (decided by the federal government)
      • Non-prescription drugs
      • Vitamins and supplements (prescription or over-the-counter)
      • Drugs received while an inpatient (these might be covered by Part A)

    Medicare Supplemental Insurance Plans

    Medicare Supplement insurance, often called "Medigap," helps pay some of the out of pocket costs not paid by Original Medicare (Parts A and B). There are ten plans standardized by the federal government. Each Medicare Supplement plan offers the same basic benefits no matter which insurance company sells it.

    • What's Covered

      All Medicare Supplemental plans provide these basic benefits:

      • Medicare Part A coinsurance and hospital costs (an additional 365 days after Medicare benefits are used)
      • Medicare Part B coinsurance or copayment
      • Part A Hospice/Respite care
      • Blood (first 3 pints each year)

      Some plans also provide additional benefits, including:

      • Medicare Part B excess charges*
      • Skilled nursing facility coinsurance or copayment
      • Foreign travel emergency**

       

      NOTE: Benefit and costs vary depending on the plan chosen.

    • What's Not Covered

      • Long-term care
      • Routine eye exams or eyeglasses
      • routine hearing test or hearing aids
      • Routine dental exams, cleaning or X-rays
      • Private duty nursing
      • Prescription drugs
     

    Seven Plan Combination Options

    Medicare isn't one-size-fits-all. You can combine different plans, offered through the government and private insurance companies, to get the coverage that's a good fit for you. Keep in mind that your health care and budget needs may change over time. When they do, you can be assured there's an option for you.

    There are seven different combinations of plans to choose from

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    Enroll with RMHP

    RMHP is here to help! Here’s how you can enroll in an RMHP Medicare Advantage or Dual Special Needs Plan.

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    Choose a plan and enroll online.

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    Call 866-568-3706 (TTY:711), and speak to a licensed agent.

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    Find a meeting in your community.

     

    Medicare Disclaimer

    This page was last updated: 10/01/2020. Please call to confirm you have the most up to date information about our Medicare plans.

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    Important Disclaimers: RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan's contract renewal with Medicare. Other pharmacies, physicians, providers are available in our network. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult http://www.medicare.gov.   Every year, Medicare evaluates plans based on a 5-star rating system.  If you need help finding a network provider, please call 800-346-4643  (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org

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    Let's Find A Medicare Plan That's Right For You

    Since 1977, Colorado retirees like you have trusted RMHP to get the most out of their Medicare benefits. Enjoy easy enrollment, flexible options, and a large provider network when you choose RMHP. Let us help you enjoy your retirement.

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