Looking for a new Medicare Advantage Plan?

At Baptist Health Plan, we are committed to making a significant impact on the lives of Kentuckians and all the communities we serve. As a locally-owned and operated organization, it’s a mission near and dear to our hearts.

Baptist Health Plan Advantage (HMO) is an affordable option with comprehensive benefits.

Baptist Health Plan Advantage makes getting care simple. By bringing our health system together with our health plan, we can offer a convenient and personalized experience for our members.

Enroll in Baptist Health Plan Advantage.

Explore our site to help you better understand Medicare and Baptist Health Plan Advantage. Use the navigation panel at the top of the page to guide you through:

  • The different parts of Medicare
  • Plan details and benefits
  • The Baptist Health Plan Advantage network of providers, locations and services
  • Helpful resources, support and more

While we have created this site to help you better understand Medicare and your plan options, we are here when you need us for support and to answer your questions. You can contact us directly and speak with one of our customer support representatives by calling toll free 844.405.1763. TTY users should call 844.708.1389. From Oct. 1 through Feb. 14, a representative will be available to speak with you from 8 a.m.- 8 p.m. in your local time zone, 7 days a week. Beginning Feb. 15 through Sept. 30, a representative will be available to speak with you from 8 a.m.-8 p.m. in your local time zone, Monday- Friday.

MEDICARE BASICS

What is Medicare?

Medicare is the federal health insurance program for people age 65 and older. It also provides insurance for people under 65 with certain disabilities and people of all ages with End-Stage Renal Disease.

Medicare—often called Original Medicare—consists of two parts:

  • Part A: Coverage for hospital stays, home health services and hospice care
  • Part B: Coverage for doctors’ services, outpatient care and medical equipment

Original Medicare does not pay for everything. That is where a Medicare Advantage plan can help.

Medicare Part A
  • Provides coverage for hospital stays, home health services and hospice care
  • Part of what is called “Original Medicare”

You can think of Medicare Part A as hospital insurance. It covers services that include

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice
  • Home health services

Medicare Part A Eligibility

You are eligible for Medicare Part A if you

  • Are 65 years or older
  • Are a citizen or permanent resident of the United States
  • You or your spouse worked for at least 10 years in Medicare-covered employment

 

To learn more about Medicare Part A and how to enroll, visit the federal government’s Medicare Eligibility Tool

When you are eligible, you will automatically be enrolled in Medicare Part A if you already receive benefits from Social Security or from the Railroad Retirement Board (RRB). If you are not getting Social Security benefits or are still working, you may need to sign up for Part A, even if you are eligible to receive Part A at no cost.

You must have Original Medicare Part A coverage before you can enroll in Baptist Health Plan Advantage. Members of a Medicare Advantage plan continue to pay the Original Medicare Part B premium in addition to any other premiums associated with the Medicare Advantage plan.

Baptist Health Plan Advantage (HMO), our Medicare Advantage plan, includes coverage for everything covered under Medicare Part A.

 

Medicare Part B
  • Provides coverage for doctors’ services, outpatient care and medical equipment.
  • Part of what is called “Original Medicare”

Like Medicare Part A, Medicare Part B is part of Original Medicare. It is purchased from the federal government, and most people pay a monthly premium. This premium is usually deducted from your Social Security check. Medicare Part B covers services such as

  • Visits to a primary care physician or specialist’s office
  • Preventive services, such as flu shots and mammograms
  • Lab and X-ray services
  • Ambulance services
  • Clinical research
  • Outpatient surgery
  • Durable medical equipment (DME)
  • Outpatient physical therapy
  • Mental health care
  • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Medicare Part B does not cover certain types of outpatient care, such as comprehensive annual physical exams and routine vision and preventive dental services.

Medicare Part B Eligibility

You are eligible for Medicare Part B if you

  • Are 65 years or older
  • Are a citizen or permanent resident of the United States
  • You or your spouse worked for at least 10 years in Medicare-covered employment

Note: You may also be eligible for Medicare Part B coverage if you have a disability or have been diagnosed with End-Stage Renal Disease.

To learn more about Medicare Part B and how to enroll, please visit the federal government’s Medicare Eligibility Tool

You must have Original Medicare Part B coverage before you can enroll in Baptist Health Plan Advantage. You must continue to pay your Medicare Part B premium.

Baptist Health Plan Advantage (HMO), our Medicare Advantage plan, includes coverage for everything covered under Medicare Part B.

 

Medicare Advantage (Part C)
  • Also known as a Medicare Advantage plan
  • Includes everything covered under Medicare Part A and Part B in one plan, plus added benefits like a prescription drug plan, and routine vision and preventive dental coverage
  • Baptist Health Plan Advantage (HMO) is a Medicare Advantage plan

Medicare Part C is also known as Medicare Advantage. It is a type of Medicare health coverage offered by private companies. As healthcare costs continue to rise, Original Medicare may not offer you enough coverage. Without the added protection of a Medicare Advantage plan, you could end up paying higher medical expenses out of your own pocket, especially if your health status requires specialists, extended hospital stays and expensive prescription drugs.

Baptist Health Plan Advantage is a Medicare Advantage plan for parts of Kentucky and all the communities we serve.

With Medicare Advantage, you are covered

  • For all the services normally covered under Original Medicare (Medicare Part A and Part B)
  • For prescription drugs under Medicare Part D
  • For additional health care coverage and benefits not included in Original Medicare, which is why many eligible individuals enroll in these types of plans

Rest assured, if you choose a Medicare Advantage plan instead of Original Medicare, you do not lose your coverage for Medicare Parts A and B.

Learn more about the extra benefits and services covered under Baptist Health Plan Advantage.

Medicare Advantage (Part C) Eligibility

To qualify for a Medicare Advantage plan, you must

  • Enroll in Medicare Part A and have Part B coverage
  • Live within the Plan’s service area.

Note: Unlike Original Medicare, it is less likely you will qualify for Medicare Advantage if you have been diagnosed with End-Stage Renal Disease.

Enroll in Baptist Health Plan Advantage.

 

Medicare Part D
  • Provides prescription drug coverage
  • Not a part of Original Medicare and must be purchased separately unless you enroll in a Medicare Advantage plan like Baptist Health Plan Advantage

Original Medicare (Part A and Part B) does not cover prescription drugs. However, Medicare offers an optional program, Medicare Part D, which provides insurance to help you pay for prescriptions. This involves paying an extra monthly premium.

Medicare Part D, also known as prescription drug plans (PDP), provides this coverage for people enrolled in Original Medicare (Part A and Part B) through private companies. Coverage to help you pay for prescription drug costs is available either through stand-alone PDPs or in combination with a Medicare Advantage plan like Baptist Health Plan Advantage.

Medicare Part D Eligibility

To qualify for a Medicare Part D, you must

  • Be entitled to Medicare Part A and/or enrolled in Part B
  • Live within the Plan’s service area

Baptist Health Plan provides Part D coverage with the Baptist Health Plan Advantage plan. If you enroll in Baptist Health Plan Advantage, you will have insurance coverage for brand-name and generic prescription medications. You will pay a part of the cost of your prescriptions through copayments or coinsurance. For full benefit details, please see our Baptist Health Plan Advantage 2017 Pharmacy Benefits.

Limits of Medicare Part D Plans

Many Medicare drug plans have an initial limit—often called the “donut hole” or “coverage gap”—on how much they cover. During any particular plan year, some people who have high prescription costs may reach this coverage gap. After you reach this limit, you may have to pay 100% of your drug costs before Medicare coverage kicks in.

Baptist Health Plan Advantage includes Medicare Part D prescription drug coverage at no additional cost. That means, if a Baptist Health Plan Advantage plan member hits the coverage gap, he or she will pay only the copay ($3 for a 30-day supply) for preferred generic drugs. For other drugs, Baptist Health Plan Advantage will follow Medicare’s pricing guidelines. For full benefit details, please see Our Plans and Benefits.

How to Enroll in a Medicare Part D Plan

You can enroll in a Medicare Part D Plan when you are first eligible, which is a seven-month time period called the Initial Enrollment Period. This timeframe is broken down into three months before the month of your 65th birthday to three months after the month of your 65th birthday.

If you have a disability, you can enroll in a prescription drug plan three months before and three months after your 25th month of disability payments.

 



DISCLAIMERS
Baptist Health Plan Advantage is a HMO plan with a Medicare contract. Enrollment in this plan depends on contract renewal with CMS. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on Jan. 1 of each year. You must continue to pay your Medicare Part B premium. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.


H8289_WEB2017 Approved

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Last Updated: 10/01/2016, 08:28 am