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
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
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
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
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