You have three basic choices for Medicare coverage , Original Medicare (just Parts A and B ), Original Medicare with a Medicare Supplement plan, or a Medicare Advantage plan. Medicare Part A helps with hospitalization, skilled nursing facilities, home health care, and hospice expenses and if you are eligible for Medicare then it doesn’t cost you anything extra. Medicare Part B covers doctors, outpatient care, home health care, and some preventative care, but it costs extra. 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 insurance companies under contract with Medicare. You could also get a standardized medicare supplement, 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 advantages of having original Medicare with a Medigap plan are that you can go to any doctor, hospital, or medical provider that accepts Medicare.
Medicare Advantage plans use networks like PPO’s and HMO’s to control costs. It depends on your plan but going to an out of network medical provider will cost probably cost. You may or may not have out of network coverage and could end up with a hefty medical bill. Most Medicare Advantage plans include coverage for your prescription medications but you out of pocket costs, like copayments and deductibles, will vary. Medicare Advantage plans also include extras like meal programs, gym memberships, vision and dental coverage.
Medicare advantage plans do not all work the same way and they will differe not only from company to company but also from state to state. For example Florida Medicare Advantage plans are not the same as Medicare advantage plans in other states. Not only do they have different service areas but also different networks and benefits. 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. Advantage plans have a lot of rules (i.e. referrals and certifications). Since Part C coverage is from private insurers you will also need to be sure your doctors accept the proposed plans. You will also be restricted to enrolling and disenrolling at certain times. You do not need to get a supplement plan if you get a medicare advantage plan. AARP United Healthcare Advantage and Supplement Plans are some of the most popular.
Many people forget to consider travel when choosing a supplement or advantage plan. Since Medicare Supplements don’t use networks you can go to any medical provider that accepts Medicare insurance. Part C Medicare Advantage plans use networks and those networks may have regional restrictions. If you plan on doing a lot of traveling you may want to look into a Medicare Supplement Plan.
Medigap policiesare health insurance plans sold by private health insurance companies to help pay for the gaps in Original Medicare coverage, 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. Medigap plans do not cover prescriptions drugs.
