As a rule, retirees and their dependents must be covered under the same type of plan. For example, if a retiree elects the HOP Medical Plan, the spouse must elect the HOP Medical Plan if he or she is eligible for Medicare or the HOP Pre-65 Medical Plan if he or she is not eligible for Medicare.
Can a spouse elect the hop medical plan if they have Medicare?
For example, if a retiree elects the HOP Medical Plan, the spouse must elect the HOP Medical Plan if he or she is eligible for Medicare or the HOP Pre-65 Medical Plan if he or she is not eligible for Medicare. However, if both are PSERS annuitants, they may elect different options.
What is the hop medical plan?
The HOP Medical Plan If you keep Original Medicare, you can supplement it by enrolling in the HOP Medical Plan. This Plan covers many of the deductibles, coinsurance and other expenses that you are required to pay under Original Medicare.
Should I Keep my Original Medicare or hop?
If you keep Original Medicare, you can supplement it by enrolling in the HOP Medical Plan. This Plan covers many of the deductibles, coinsurance and other expenses that you are required to pay under Original Medicare. In addition: You have the freedom to use virtually any health care provider (doctor or hospital) you want.
Can I enroll in a pre-65 managed care plan instead of hop?
You have an option to enroll in a Pre-65 Managed Care Plan instead of the HOP Pre-65 Medical Plan. The Pre-65 Managed Care Plans provide benefits designed especially for the Health Options Program and include both medical and prescription drug coverage. You must use a provider in the MCO's network to receive the maximum benefit.
What is Hop medical plan?
The HOP Pre-65 Medical Plan covers hospital, surgical, and medical services and offers an option for prescription drug coverage: Except for a free physical exam each year that requires no deductible, you must meet a $1,500 annual deductible before the Plan pays benefits.
What is Psers hop program?
A supplement to Original Medicare that provides coverage anywhere in the United States and abroad when you are traveling. The Health Options Program offers two Medicare Supplement plans: HOP Medical Plan. Value Medical Plan.
Do PA teachers get health insurance when they retire?
Health Insurance Options The Health Options Program operates for the sole benefit of participants of the Pennsylvania Public School Employees' Retirement System (PSERS), their dependents, and survivors. The Health Options Program offers comprehensive medical coverage before and after you become eligible for Medicare.
How do I retire as a teacher in PA?
Age 67 with a minimum of three years of service credit, or.Any combination of age and service that totals 97 with at least 35 years of credited service.
What is Medicare RX?
The Enhanced, Basic and Value Medicare Rx Options are Medicare prescription drug (Part D) plans designed specifically for HOP Medical Plan and Value Medical Plan participants and their eligible dependents. You can choose a Medicare prescription drug option with or without enrolling in the HOP Medical Plan or the Value Medical Plan.
What is the HOP pre 65?
The HOP Pre-65 Medical Plan. The HOP Pre-65 Medical Plan covers hospital, surgical, and medical services and offers an option for prescription drug coverage: Except for a free physical exam each year that requires no deductible, you must meet a $1,500 annual deductible before the Plan pays benefits.
What is Medicare Advantage Plan?
A Medicare Advantage plan combines medical and prescription drug benefits in a single program.
How much does Medicare pay for hospital visits?
You pay nothing for covered hospital and medical expenses, except for $10 per physician visit or $20 per specialist visit. You’re covered anywhere in the United States and abroad when you are traveling. You can add prescription drug coverage by enrolling in the Enhanced, Basic or Value Medicare Rx Option.
What insurance companies offer Medicare Advantage plans?
Medicare Advantage plans available through the Health Options Program are offered by Highmark, Aetna, Independence Blue Cross, Capital BlueCross and UPMC. These insurance companies have contracted with the federal government to provide Medicare benefits. Each insurance company sets its own benefits and member rates.
What is a pre 65 plan?
The Pre-65 Managed Care Plans provide benefits designed especially for the Health Options Program and include both medical and prescription drug coverage. You must use a provider in the MCO's network to receive ...
How much does Value Medical Plan cover?
You pay a $300 per admission copay if you are admitted to the hospital, then the Plan pays 100% of Medicare's hospital deductible and daily copays. The Value Medical Plan coverage for services provided abroad is limited to those covered by Medicare.
How long can you live in hospice?
Things to know. Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies ...
What happens when you choose hospice care?
When you choose hospice care, you decide you no longer want care to cure your terminal illness and/ or your doctor determines that efforts to cure your illness aren't working . Once you choose hospice care, your hospice benefit will usually cover everything you need.
How long can you be in hospice care?
After 6 months , you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re still terminally ill. Hospice care is usually given in your home but may also be covered in a hospice inpatient facility. Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. When you choose hospice care, you decide you no longer want care to cure your terminal illness and/or your doctor determines that efforts to cure your illness aren't working. Once you choose hospice care, your hospice benefit will usually cover everything you need.
What is hospice care?
hospice. A special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. Hospice also provides support to the patient's family or caregiver. care.
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. for inpatient respite care.
Does Medicare cover hospice care?
Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends. Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
Can you stop hospice care?
As a hospice patient, you always have the right to stop hospice care at any time. Prescription drugs to cure your illness (rather than for symptom control or pain relief). Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose.
How many stars does Medicare have?
The Health Options Program’s prescription drug plans have maintained a 4-star rating or better since inception, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.
What is the Health Options Program?
The Health Options Program offers online resources to help make it easier for you and/or your authorized representative.
What is a medical social service?
Medical social services. Part-time or intermittent home health aide services (personal hands-on care) Injectible osteoporosis drugs for women. Usually, a home health care agency coordinates the services your doctor orders for you. Medicare doesn't pay for: 24-hour-a-day care at home. Meals delivered to your home.
What is intermittent skilled nursing?
Intermittent skilled nursing care (other than drawing blood) Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition.
What is an ABN for home health?
The home health agency should give you a notice called the Advance Beneficiary Notice" (ABN) before giving you services and supplies that Medicare doesn't cover. Note. If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. ...
What is the eligibility for a maintenance therapist?
To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition , or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. ...
Can you get home health care if you attend daycare?
You can still get home health care if you attend adult day care. Home health services may also include medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.
Does Medicare cover home health services?
Your Medicare home health services benefits aren't changing and your access to home health services shouldn’t be delayed by the pre-claim review process.
Do you have to be homebound to get home health insurance?
You must be homebound, and a doctor must certify that you're homebound. You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services.
How to contact HOP for three person insurance?
If that is your case, or you have other questions about the premiums, available coverage or you need rates for three-person premiums, please call the HOP Administration Unit at 1-800-773-7725.
What if my spouse is not eligible for Medicare?
If your spouse is not eligible for Medicare, he or she must enroll in the same type of plan as you—for example, the HOP Pre-65 Medical Plan if you enroll in either the HOP Medical Plan or the Value Medical Plan.
Can a spouse be eligible for Medicare if they are not eligible?
If your spouse or dependent is not eligible for Medicare and you elect the Enhanced, Basic or Value Medicare Rx Option on a standalone basis, your spouse or dependent will not be eligible for coverage through the Health Options Program until he or she becomes eligible for Medicare. Last modified December 30, 2019.
What are the three Medicare Advantage plans?
The Health Options Program offers three Medicare prescription drug plans: Enhanced Medicare Rx Option. Basic Medicare Rx Option. Value Medicare Rx Option.
How many stars does Medicare have?
The Health Options Program’s prescription drug plans have maintained a 4-star rating or better since inception, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.
What is the Health Options Program?
The Health Options Program operates for the sole benefit of participants of the Pennsylvania Public School Employees ' Retirement System (PSERS), their dependents and survivors. The Health Options Program offers comprehensive medical coverage before and after you become eligible for Medicare.
Can you enroll in MetLife Dental and EyeMed Vision?
You can enroll in the MetLife Dental and EyeMed Vision Option if you enroll in either the HOP Medical Plan or the Value Medical Plan. The MetLife Dental and EyeMed Vision Option is not available on a standalone basis or with a Medicare Advantage plan. Medicare Advantage Plans.
Who must decide whether or not to participate in the hospital, medical/surgical, prescription drug and dental + vision coverage?
Eligible retirees, dependents or survivors, must decide whether or not to participate in the hospital, medical/surgical, prescription drug and dental + vision coverage and take advantage of a program designed exclusively for you.
Can you choose a Medicare Supplement Plan instead of a Managed Care Plan?
Instead of choosing a Medicare Supplement plan, you can choose a Managed Care Plan, which requires you to use the plan's network of providers to receive the maximum benefit. Reasons to Join the Health Options Program. Designed with you in mind. Unlike health care programs created for the public at large, ...
Medicare Advantage (Part C)
You pay for services as you get them. When you get a covered service, Medicare pays part of the cost and you pay your share.
You can add
You join a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.
Most plans include
Some extra benefits (that Original Medicare doesn’t cover – like vision, hearing, and dental services)
Medicare drug coverage (Part D)
If you chose Original Medicare and want to add drug coverage, you can join a separate Medicare drug plan. Medicare drug coverage is optional. It’s available to everyone with Medicare.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare.