At this stage in your life, you may be exploring your Medicare options. Original Medicare does not cover all medical expenses, and you may want to consider a supplemental plan. Options for additional coverage can include Supplemental Plans (Medigap) and Medicare Advantage Plans.
Keep reading to learn more about both possible options for your healthcare needs!
Medicare Part A and Part B are both included in Original Medicare. Part A is hospital insurance and Part B is medical insurance. Prescription drug coverage is not included and will need to be obtained separately. Options for this include Medicare Part D or a Medicare Advantage Plan. You can use any doctor or facility that accepts Medicare.
Medicare Supplements or Medigap plans were created to fill in the “gaps” that may occur with your regular Medicare coverage. Some of the gaps that can be covered include coinsurance, deductibles and copayments. Supplement plans are sold by private companies and each plan varies.
Medicare Supplement plans include benefits that are different from what regular Medicare offers. Some of these benefits include medical care when traveling, blood transfusions, deductibles and excess charges.
If you purchase a Medigap plan, your original Medicare will pay its share first. After this, your Medigap plan will kick in.
To have a Medigap plan, you must have Medicare Part A and Part B. Medigap is only a supplement to your Medicare. It is not standalone insurance. You will be paying a separate monthly premium to the private company that holds your Medigap plan. This will be in addition to your Medicare premiums. Each Medigap policy only covers one person. Each person must have their own policy. Policies sold after 2006 do not include prescription drug coverage.
Medicare Advantage Plans
Medicare Advantage plans are an additional way to obtain your Medicare Part A and Medicare Part B coverage. These plans are also called MA and Part C plans. These plans are offered by private companies that Medicare has approved. Most Medicare plans include prescription drug coverage (Part D).
Types of Medicare Advantage Plans include Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO), Private Fee-for-Service Plans (PFFS) and Special Needs Plans.
Preferred Provider Organizations offer doctors and other healthcare providers that are “in-network” and “out of network.” Generally, your costs will be lower if you use a provider that is considered “in-network.”
Health Maintenance Organizations are more strict. You must get your healthcare “in-network” unless you have an emergency or need out-of-area urgent care.
Private Fee-for-Service Plans determine how much they will pay the healthcare providers and how much you will pay out-of-pocket.
Special Needs plans are only for individuals with a specific diagnosis or characteristic.
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As you can see, there are many options to consider with your Original Medicare coverage. At Medicare Detectives, we understand that these options can be confusing, which is why we are here to help you make an informed decision for your healthcare needs.
If you have any further questions about your Medicare Supplement and Medicare Advantage options, give us a call today!