The Original Medicare Plan is a fee-for-service option that offers coverage for most health care services and only some prescription drugs. The insured can only go to medical facilities and see doctors that accept Medicare insurance. The individual being covered receives a red, white or blue Medicare card to present to the physician.
The deductible must be met before Medicare begins to contribute their share of the medical bills. Since it is a fee-for-service plan, each time you receive a service, you are required to pay a portion - possibly 15% or 20% depending on your policy; the same goes for when purchasing supplies, such as an inhaler or prescription glasses.
Policies to Fill in the Gaps
Being that Medicare doesn't pay for certain services, supplies or medications, some may need an alternative. A medigap plan can be used; it is a policy sold by private insurance companies. The coverage helps the insured to pay for medical gap expenses and for health care outside of the United States. Both the original and Medigap Medicare plans can be used to pay for covered health care costs.
Plans for Prescription Drugs - Medicare Part D
This option is good for those who have an original Medicare program that doesn't cover all of the prescription drugs they are required to take. This can also be added to
Individuals choose to go with this option because they don't have to pay as much for their prescription drugs. Once the individual is enrolled in the program, they receive a card that is used to present to the pharmacist at the time of purchase. If there are any co-payments, coinsurance and/or deductibles, they must be paid by the individual. There is extra help available for those who have limited income and resources; financial assistance is given to pay the Medicare Drug Plan expenses.
Medicare Advantage Health Plan Options
To go along with your Medicare insurance, you can choose to go with other Advantage Plans that are approved by Medicare and run by private insurance companies; by enrolling in one of them doesn't mean you are no longer with Medicare; they coexist. Many individuals opt for these plans to get additional coverage that Medicare doesn't provide, such as for certain drugs, eyeglasses or medical services and treatments. The costs for each plan vary, though many Medicare Advantage plans actually have no premium at all (yes, they are free).
With some of the plans, you are required to use their network of physicians and hospitals, like with the HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Sometimes the costs for the premiums or services are lower than the Original Medicare Plan, with and without the Medigap Policy included. The advantage plans provided do include hospital (Part A) and medical (Part B) coverage and are required to cover services that are necessary for your medical needs. The Medicare plans can sometimes be used to provide cheaper drugs than the Medicare Prescription Drug options. Some plans coordinate your care by utilizing referrals and networks, which can end up saving you money and improve the management of your health care. Another great advantage these plans give is that you don't have to purchase a Medigap policy.
Here are your plan options:
Which Plan to Choose?
Here is an overview of each plan:
HMO - This is a health plan that offers Part A and Part B coverage; some have extras that pay for extended hospital stays. You are only required to use their network of doctors as your Primary Care Physician (PCP); except during emergencies. Costs for this option is sometimes lower than the Original Medicare Plan.
PPO - With this plan you are given the option to use their network of doctors for cheaper co-payments. Additional costs are applied for use of out-of-network physicians.
PFFS - More freedom is given with this plan because you can use any Medicare-approved doctors and medical facilities that accept your insurance. You are required to pay a specified percentage of medical costs as they are endured. Extra benefits are sometimes included.
MSA - You are required to be an enrollee in a high-deductible plan, which doesn't give coverage until the annual deductible is met. Medicare deposits money into the savings account that is used for any health care expenses. Most Medicare Advantage plans, including those with no monthly premium, are MSA plans.
Medicare Special Needs Plan - This is a special kind of plan that offers Part A and Part B coverage to those needing special care for chronic illnesses. Those eligible include individuals in nursing homes, those qualified for Medicaid/Medicare and individuals with disabling or chronic conditions.
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