Essence Healthcare Essential Information
Enrollment Information & Your Choices
There are certain times of the year when you can change the way you get Medicare. These are the rules:
- From November 15 through December 31, during the Annual Coordinated Election Period (AEP), anyone with Medicare may switch from one way of getting Medicare to another for the following year. Your change will take effect on January 1. During the AEP, you are not limited in the type of change you may make to your coverage.
- From January 1 until March 31, during the Medicare Advantage Open Enrollment Period (OEP), anyone eligible for Medicare Advantage has another chance to review the coverage they have and make one change. Your new enrollment will be effective the first day of the month that comes after the month you notify the plan of a change. However, with this chance, you are limited in the type of plan you may join. You may not use this chance to add or drop Medicare prescription drug coverage.
Outside of these time periods, you generally can't make any other changes during the year unless you meet special exceptions, such as if you move, if you have Medicaid coverage, or if you get extra help in paying for your drugs.
For more information about these times and the choices available to you, see your Medicare & You 2008 Handbook. The handbook is mailed to everyone with Medicare each Fall. You may also visit www.medicare.gov on the web or call 1-800-MEDICARE (1-800-633-4227) to learn more about your choices. TTY users should call 1-877-486-2048.
What are my choices?
From November 15 to December 31, anyone with Medicare can switch from one way of getting Medicare to another for the following year. During this Annual Enrollment Period, you have the opportunity to choose the plan that is best for you. These are the following types of plans:
- Other Medicare Advantage Plans (including HMO's such as Essence, PPO's and Private Fee-for-Service Plans) are available in some parts of the country. In HMO's and PPO's, you generally get all your Medicare-covered Part A and Part B health care through the plan. Medicare Advantage Plans may include prescription drug coverage as part of the Medicare Prescription Drug (Part D) benefit. Medicare pays a set amount of money for your care every month to these private health plans whether or not you use services. Essence is a Medicare Advantage Plan offered by Essence.
- Original Medicare is available throughout the country. Original Medicare is a fee-for-service health plan that lets you go to any doctor, hospital, or other health care provider who accepts Medicare. You must pay a deductible. Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance). Original Medicare has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
- Medicare Prescription Drug Plans (PDP's) are stand-alone drug plans that only cover prescription drugs, not other benefits or services. If you choose Original Medicare and want to receive Medicare prescription drug coverage, you must join a Medicare Prescription Drug Plan.
- Other Medicare Health Plans (including Medicare Cost Plans, Programs of All-Inclusive Care for the Elderly (PACE), and Demonstrations) may be available. In some of these plans, you generally get all your Medicare-covered health care from that plan. This coverage may include prescription drug coverage.