Your Medicare Coverage Choices

November 12, 2016

Before enrolling in a Medicare Health Insurance Plan, make sure you know about the options available to you. Here is a brief helpful guide.

There are two main ways to get coverage: Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C).  Additional coverage can be sought with Prescription Drug Plans (Part D), and Medicare Supplement Plans (Medigap).  Let us look at each one of these in some more detail.

Original Medicare

This includes Part A which covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some health care; and Part B which covers certain doctors’ services, outpatient care, medical supplies, and preventive services.  For both Part A and Part B, the choice of doctors, hospitals, and other providers that accept Medicare, is available to beneficiaries.

Upon reaching the age of 65, most seniors will become eligible for Original Medicare Insurance because they have been paying Medicare taxes for at least 10 years while being employed.  If this is not the case, you can enroll with Original Medicare in the Initial Enrollment Period, which is the 7-month period starting 3 months before your birthday month, and lasting until 3 months after it.

Advantage Plans

These are private insurance plans that offer all-in-one medical and drug coverage in collaboration with all Medicare Part A and Part B plans.  These plans may offer extra coverage like vision, hearing, dental, and/or health and wellness programs.  They are offered by private companies in contract with Medicare.

Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), HMO Point Of Service (HMOPOS), and Medical Savings Account Plans (MSA).

  • Health Maintenance Organization (HMO): allows beneficiaries to visit any physicians and hospitals in the HMO network.
  • Preferred Provider Organizations (PPO): allows beneficiaries to seek treatment from practitioners in the PPO network. Others can be consulted for an additional fee.
  • Private Fee For Service (PFFS): allows beneficiaries to use any doctor as long as the practitioner agrees to the terms of PFFS. The terms can be decided while choosing the plan.
  • Special Needs Plan (SNP): assists people with disabilities, and certain medical conditions for which customized plans are required. This plan includes Medicare Prescription Drug Coverage.
  • HMO Point Of Service (HMOPOS): allows beneficiaries to designate an in-network physician to be their primary care provider, but beneficiaries may choose to go outside of the provider network for health care services.
  • Medicare Savings Account (MSA): allows beneficiaries to escape the cost of the monthly premium after the deductible is met.  This is done by maintaining a health care costs savings account for the user.

You can enroll with Advantage Plans in the Initial Enrollment Period, or in the Open Enrollment Period lasting from October 15 to December 7.  You must be enrolled with Original Medicare to enroll with Advantage Plans.

Prescription Drug Plan

This plan adds prescription drug coverage to Part A and B.  Prescription Drug Plans are offered by private companies approved by Medicare.  Most, but not all, Advantage Plans offer prescription drug coverage.  If your Advantage Plan does not offer drug coverage, you can join a Prescription Drug Plan.

All people having Part B coverage can opt to enroll with Part D in the Initial Enrollment or Open Enrollment Periods.

Medicare Supplement Plan

You may want to get coverage to help pay some of the health care costs that Part A and B don’t cover.  These include copayments, coinsurance, and deductibles.  If you need this additional coverage, you may want to enroll with Medigap.  If you are enrolled in an Advantage Plan, you can’t use Medigap to pay for your plan costs.

The best time to enroll with Medigap is the Open Enrollment Period.

This is not a complete description of Medicare or other available plans. Detailed information on Medicare Insurance Plans can be found on www.medicare.gov and www.medigap.org.

Source: www.medicare.gov

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