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Coverage and Benefits

Health Coverage

Outline of Coverage

The Health Tradition 65Plus Outline of Coverage contains detailed information about our 65Plus Medicare Select plan.

All health care services received under 65Plus must be obtained from in-network health care providers except for emergency care, urgent care and authorized referrals.

Coverage at a glance

  • 100% coverage of the Medicare Part A deductible and coinsurance
  • 100% coverage of Medicare Part B coinsurance
  • Preventive care including: annual physical, vision and hearing exams
  • Worldwide emergency and urgent care coverage
  • Skilled nursing facility care
  • Hospice and home health care
  • Inpatient and outpatient mental health care
  • Chiropractic care

65Plus provides coverage for diabetic testing supplies, such as test strips, lancets, and blood glucose monitors. Diabetic testing supplies may be purchased at any local pharmacy or mail-order supplier that is enrolled with Medicare.

As of July 2013, Medicare has a National Mail-Order Program for diabetic testing supplies that are delivered to your home. Please visit www.medicare.gov or call 800.Medicare (800.633.4227) for more information on diabetic suppliers.

Ask the supplier if they will file your claim to 65Plus for the Medicare out-of-pocket amounts, otherwise, you may have to file your own claims for reimbursement.

Additional Wellness Benefits

Prevention and Wellness Benefits

Health insurance that helps you stay well

Health Tradition gives you high-quality wellness programs designed specifically to help make healthcare easier, more convenient and more affordable.

SilverSneakers®: provided free of charge to you as part of your 65Plus plan.

The SilverSneakers fitness program gives you access to exercise equipment and other amenities at 17,000+ participating locations. Trained instructors are available for support, and fitness classes are designed for all fitness levels and abilities.

Prevention is essential

Preventive care services and promotion of healthy lifestyles are central to Health Tradition’s philosophy of care. For this reason, the following preventive care services are covered at 100% when received from network providers:

  • Annual physical exam
  • Annual vision exam
  • Annual hearing exam

For a full listing of preventive and screening services covered by Medicare Part B, please visit the Medicare website at: Medicare’s Preventive Services.

Important Dates

Opportunities to Learn and Enroll

Medicare countdown checklist

Use this checklist to prepare for your transition to Medicare coverage. View and download the checklist here.

Medigap enrollment periods

  • Open enrollment

Medicare Select insurance companies must make coverage available to you, regardless of your age, for six months beginning with the date you enroll in Medicare Part B. If you are under the age of 65 and enrolled in Medicare due to disability or end-stage renal disease, you are entitled to another six-month open enrollment period upon reaching age 65.

  • Guaranteed issue

In addition to open enrollment periods, there are additional opportunities to enroll. Some of them give you guaranteed acceptance regardless of health status.

Annual enrollment period (AEP)

  • October 15 – December 7

Each year, you can make changes to your Medicare Advantage or Medicare Prescription Drug plan for the upcoming year. During the annual enrollment period, anyone can join, switch or drop a Medicare Advantage Plan or Medicare Part D plan.

Medicare Advantage disenrollment period (MADP)

  • January 1 – February 14

You can switch from a Medicare Advantage plan (except an MSA plan) to Original Medicare during the Medicare Advantage Disenrollment Period (MADP). You can only make this coverage change if you have a Medicare Advantage plan. The MADP occurs every year from January 1 to February 14.



Health Tradition 65Plus FAQs

What is Health Tradition 65Plus

Health Tradition 65Plus is an HMO Medicare Select plan that pays benefits only if covered services are obtained through network providers contracted by the insurance company. This will not impact Medicare payments and Medicare still pays its share of approved charges if the services you receive are outside the network. 65Plus works with your existing coverage under Medicare, protecting you against expenses you would otherwise have to pay with the Medicare program. You’ll have excellent benefits and coverage for:

  • Medicare part A deductible
  • Medicare part A skilled nursing facility coinsurance
  • Medicare part B coinsurance
  • Home health care
  • Mental health
  • Preventive screenings
  • Foreign travel Wisconsin mandated benefits and much more!

Is the 65Plus plan administered locally?

Yes. We are Wisconsin-based and have been protecting Wisconsin seniors for more than 30 years. Our knowledgeable team is available by phone or in-person at Southern Wisconsin office. You’re welcome to stop in or call to discuss your coverage.

Does 65Plus replace my Medicare insurance?

No. It adds to the coverage you automatically receive when you enroll in Medicare. When you join the plan, you are able to keep your original Medicare Part A and Medicare Part B coverage.

Can my coverage be cancelled?

No. Your Health Tradition 65Plus policy is guaranteed renewable for life and cannot be cancelled as long as you meet eligibility requirements and continue to make your premium payments

Does 65Plus offer Medicare Part D prescription coverage?

No. You may purchase a separate Medicare Prescription Drug Plan (Part D) from a private insurance company. More information on Part D plans can be found at www.medicare.gov.

What are some things to consider when shopping for a Medicare Select plan?

  • Look at total costs

When comparing your options, think about more than only your monthly premium, especially if you want a predictable monthly budget. Unexpected copays, coinsurance, deductibles and other non-covered charges can add up to a substantial financial burden. Medicare Select plans work with your existing Medicare coverage to help cover many of these costs.

  • If you work beyond age 65

You may save money by delaying enrollment in Part B if you have coverage through your job. Some group plans change benefits at age 65, so be sure to check with your human resource department to help evaluate your options and plan a transition to Medicare.

  • Be aware of the penalty for Part D late enrollment

A penalty is added to your Part D premium if you go without creditable prescription drug coverage. The cost of the penalty depends on how long you went without creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the ‘national base premium’ times the number of uncovered months. The national base beneficiary premium may increase each year, so your penalty may also increase each year. You will have to pay this penalty for as long as you have a Medicare drug plan.

  • Beware of fraudulent offers

You can’t be enrolled in both a Medicare Advantage plan and a Medicare Medigap plan at the same time. A Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles or premiums. If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare.

 

This is an advertisement for insurance. In offering Medicare Select insurance, neither Health Tradition Health Plan nor its agents are connected with Medicare.

HT MC 3025