| Medicare
Advantage Plans 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 - Medicare
Cost Plans
- Some
Medicare Private Fee-for-Service Plans
- Medicare
Medical Savings Account Plans
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:
- Health
Maintenance Organization (HMO)
- Preferred
Provider Organization (PPO)
- Private
Fee-for-Service (PFFS)
- Medicare
Medical Savings Account (MSA)
- Medicare
Special Needs Plans
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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