What is Medicare?
Medicare is a federal health insurance program, typically available to people age 65 and older or those with qualifying medical conditions. There are four separate Medicare programs, each providing different types of coverage. Parts A and B are known as “Original Medicare” and provide coverage for hospital stays (Part A) and outpatient services and supplies (Part B). Medicare Part C – also known as Medicare Advantage – provides alternative coverage to Original Medicare. Part D provides coverage for medications.
So how is Medicare Advantage different?
Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide health coverage. Medicare Advantage plans must cover everything included by traditional Medicare plans, but may offer more benefits and/or lower copays.
One Medical now accepts several Medicare Advantage plans in New York. For example, we are in network with Humana's New York Medicare Advantage HMO plans to better serve our Medicare-eligible members.
Advantages of Medicare Advantage HMO Plans
- Low monthly premiums
- Medicare Advantage plans have an annual limit on your out-of-pocket expenses
- Medication coverage (Part D) is often included as part of your Medicare Advantage plan
- Plans may cover services that Original Medicare doesn’t, such as routine vision, dental, and hearing care
- The One Medical annual membership fee (a $199 value) is included in these plans
As is common with HMO plans, Medicare Advantage patients must see doctors, hospitals, and specialists that are in their chosen network. This is different from traditional fee-for-service Medicare plans in which patients have broader physician choice but often higher costs.
Timing and Process for Enrolling
The Open Enrollment period for 2016 Medicare plans runs from October 15 through December 7, 2015. During this period, you can:
- Update your plan from Original Medicare to Medicare Advantage
- Switch from one Medicare Advantage plan to another
- Change from Medicare Advantage back to Original Medicare
Eligible patients who select a Medicare Advantage HMO can then select a One Medical provider as their primary care provider ("PCP"). Once enrolled in a qualifying Medicare Advantage HMO plan, you can activate/update your One Medical membership.
Please visit medicare.gov for general information about Medicare.
If you have any questions, please call one of our advisors at 212-441-4429.