Medicare Insurance Plans | Medicare Insurance Coverage
There is a lot of information about Medicare insurance plans and Medicare insurance coverage, and sorting through all of it can be very time consuming. It doesn’t have to be difficult. Here is some general information on Medicare insurance plans and some other Medicare insurance resources to help you find a plan that fits you.
Medicare Part A Coverage and Medicare Part B Coverage
Original Medicare is made up of Medicare Part A and Medicare Part B. Medicare Part C and Medicare Part D are NOT part of Original Medicare. Medicare Part A coverage helps with hospitalization, skilled nursing facilities, home health care, and hospice expenses. Medicare Part B coverage helps cover doctors, outpatient care, home health care, and some preventative care. Medicare Part C, also know as Medicare Advantage Plans are plans offered by private companies that are approved and under contract with Medicare. Medicare Part C HMO and PPO plans include Medicare Parts A and B, sometimes D. Medicare Part D is for prescription drugs and is also run by private companies under contract with Medicare. Basically, you have two choices: Original Medicare with a Medigap / Medicare Supplement plan OR a Medicare Advantage / Medicare Part C plan.
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You can get a standardized Medicare Supplement plan, Medigap plan, to help cover those expenses (deductibles and coinsurance) not paid by Medicare. Medicare supplement plans do not cover prescription drugs. So if you want prescription drug coverage you will have to join a Medicare prescription drug plan. I think the biggest advantage of having original Medicare with a Medigap plan are that you can go to any doctor, hospital, or medical provider that accepts Medicare. The biggest advantage of having a Medicare Advantage / Medicare Part C are that monthly premiums are lower, sometimes $0, depending on the plan and the provider.
Medicare Advantage and Medicare Part C
Medicare Part C / Medicare Advantage plans have networks like HMO’s and PPO’s, and if you go out of network it will cost you more. Medicare Part C / Medicare Advantage plans include coverage equal to or better than the coverage offered by both Medicare Part A and Medicare Part B. Prescription drug coverage is included in many Medicare Advantage plans. Your total out of pocket costs (monthly premiums, copayments, deductibles, etc.) will vary from plan to plan. Medicare advantage plans may also offer extras like dental and vision coverage. HMO – health maintenance organization plans, PPO – preferred provider organization plans, POS – point of service plans, and PFFS – private fee for service plans are all examples of Medicare Advantage – Part C plans.
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Medicare Advantage / Medicare Part C plans do not all work the same way. Make sure you understand the rules, costs, and why a particular plan fits you best. The only way to insure this is to ask questions. There will be variations in the services covered as well as the costs for those services. Medicare Advantage plans have a lot of rules (i.e. referrals and certifications). Since Medicare Part C coverage is from private insurers be sure your doctors accept the proposed plans and that you are familiar with your service area. You will also be restricted to enrolling and disenrolling at certain times. You do not need to get a medicare supplement plan if you get a medicare advantage plan.
Medigap / Medicare Supplement PlansMedigap policies / Medicare Supplement plans are
health insurance plans sold by private health insurance companies to help pay for the gaps in Original Medicare coverage like deductibles and copays. In other words your share of the costs not covered by Original Medicare. Medigap plans have been designed as a supplement to Original Medicare. When you receive Medicare approved services Medicare will pay its share. Your medigap isurance policy will the help you with your share of the Medicare approved health care costs.
Medicare Part D Coverage
There are 2 ways to get Medicare prescription drug coverage, either a stand alone plan or through a Medicare Advantage Plan (HMO, PPO, PFFS, or other Part C plan). If you don’t enroll in a Medicare Part D prescription plan when you first become eligible then you will pay higher premiums if and when you do eventually enroll. This is known as the “late enrollment penalty”. Depending on the plan you choose you have a monthly premium, annual deductible, copayments, coinsurance, and “coverage gap”. Make sure you completely understand the coverage gap or “donut hole”, copayments, and your deductible.
Centers for Medicare and Medicaid Services is also a great source for information about Medicare. Start by reading “Medicare and You 2010″. This Medicare consumer guide is produced by Centers for Medicare and Medicaid Services, and it really is informative. They do an excellent job of explaining the costs, the coverage, drug plans, and most importantly your rights.
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