Medicare Plan Choices

Share

• DIGG
• DEL.ICIO.US
• LINKED IN
• FACEBOOK

Do you want to bookmark ?

Medicare is a federal health-insurance program for people who are 65 and older, for some younger people with disabilities, and for people with end-stage kidney disease.

With Medicare, you may have a choice of what form your health care takes. You can always choose the Original Medicare Plan, open to everyone with Medicare. Or you may be able to choose a Medicare Advantage plan. Those plans are offered by private insurance companies, which in turn provide your Medicare benefits. You can also choose a Medicare Drug plan to help reduce the cost of your prescription medications.

The Medicare Plans Include:

• The Original Medicare plan, sometimes called the “traditional” plan
• Medicare Advantage plans, such as:
  • Medicare Health Maintenance Organizations (HMOs)
  • Medicare Preferred Provider Organizations (PPOs)
  • Medicare Private-Fee-for-Service (PFFS) plans
• Medicare Prescription Drug plans

Remember:

• You can always choose the Original Medicare plan.
• No matter which Medicare plan you choose, you will still be in the Medicare program.
• All Medicare plans must provide at least the same benefits offered by the Original Medicare plan.
• You can change your health plan at any time for any reason, as long as the plan is accepting new members.
• If you are now in the Original Medicare plan and you’re happy with what you have, you don’t need to change.

The Original Medicare Plan

The Original Medicare plan is a fee-for-service health plan. This means that your doctor, hospital, or other health care provider gets paid for each service you receive. Under this plan, you can go to almost any doctor or hospital in the country that accepts Medicare.

In the Original Medicare plan, Medicare pays its share of the doctor or hospital bill, and you pay your share. The Original Medicare plan pays for many heath care services and supplies, but it doesn’t cover of your health care expenses. For this reason many people with Original Medicare also purchase a Medigap policy and enroll in a Medicare prescription-drug plan.

Medicare Advantage Plans

There are three main types of Medicare Advantage plans: HMOs, PPOs, and PFFSs. They are offered by private insurance companies. These plans provide all the benefits of Original Medicare and generally provide additional benefits and lower co-payments. However, there may be a limit on where you can get your care, which doctors you can see, and how often you can see them.

Medicare HMOs and PPOs

These plans pay for the same health care as the Original Medicare plan. Some plans also offer other benefits that the Original Medicare plan doesn’t cover. These benefits can include prescription-drug coverage, check-ups, vision care, and hearing aids. However, be aware that these plans often have benefits changes from year to year.

In a Medicare HMO, you can only go to doctors, specialists, and hospitals in the plan’s network. You usually need to choose one doctor, such as a family doctor or an internist, to be your main or primary-care doctor. Your primary-care doctor will coordinate all of your health care and send you to a specialist when you need one (such as a cardiologist for a heart problem). Your primary doctor can also admit you to the hospital.

Some Medicare HMOs offer a point-of-service option. This allows you to go to other doctors and hospitals that are not part of the plan’s network, but you may pay more. This option has some features similar to those of a Medicare PPO.

A Medicare PPO also has a network of doctors, specialists, and hospitals. However, in a PPO, you can go to doctors, specialists, and hospitals outside the plan’s network, but you will pay more for your care.

Since prescription-drug coverage is usually included in HMOs and PPOs, you may not need to select a separate Medicare prescription-drug plan.

Medicare Private Fee-for-Service (PFFS) Plans

You can choose any doctor or hospital that accepts the plan’s payment. The insurance company pays its share of your doctor and hospital bills, and you pay your share. However, the private insurance company, not Medicare, decides how much you pay for your care. This means you might pay more for your health care than if you were in the Original Medicare plan. However, under the PFFS plan, you may get extra benefits.

Some PFFS plans include prescription-drug coverage and some do not. Unless your prescription drugs are covered through the PFFS plan or elsewhere, you may need to select a Medicare prescription-drug plan.

Medicare Prescription-Drug Plans

Everyone needs to make decisions about prescription-drug coverage. If you have Original Medicare, you may need to select a Medicare prescription-drug plan. You may not need to purchase a drug plan if you have a Medicare Advantage Plan. Drug coverage is generally included in the Medicare HMO and PPO Plans.

Be aware that drug plans vary considerably in coverage and costs. Compare plans carefully to find the best plan for your particular needs.

You may not need to purchase additional coverage if your prescription-drug purchases are covered elsewhere (for example, by Medicaid, an employer, or a union).

Where Medicare Plans Are Available

• The Original Medicare Plan is available everywhere in the country and to everyone who signs up for Medicare.
• Medicare Advantage Plans are available in some parts of the country and not in others. Some areas have more than one Medicare Advantage plan; other areas don’t have any.
• Medicare Prescription Drug Plans are available everywhere in the country; however, plans often vary by region.

Signing Up for a Medicare Plan

The Original Medicare Plan:
If you are getting Social Security or Railroad Retirement benefits, you automatically get the Original Medicare plan (Parts A and B) when you turn 65. You’ll receive a packet of information on Medicare, including your Medicare card. If you want to join a Medicare Advantage Plan, follow the instructions in the packet.

If you are not getting Social Security or Railroad Retirement benefits, sign up for Medicare yourself by calling or visiting your local Social Security office. In this case, you direct Medicare as to the plan you want.

Medicare Advantage Plans:
If you want to join a Medicare Advantage plan (HMO, PPO, or PFFS), you must have both Medicare Part A and B and live in the service area of the plan you want to join. People with End-Stage Renal Disease are not eligible to enroll in a Medicare Advantage plan.

Medicare Prescription Drug Plans:
If you want to join a Medicare drug plan, you can contact insurance companies directly to ask for an enrollment package. You can also call Medicare toll-free at 800-633-4227 or visit Medicare.gov to get information about signing up for a plan.

Changing Plans

Generally, you can choose to switch your current plan to a new plan during open enrollment, from November 15 to December 31 of each year. Enrollment is generally for the calendar year. In special cases, such as if you move or enter a nursing home, you can switch plans outside the open-enrollment period.

If you decide to switch plans you can:

• Write or call your plan,
• Call Medicare toll-free at 800-633-4227
• Contact the Social Security Administration

After you ask to switch, your plan will let you know, in writing, the date your coverage begins. If you don’t get a letter, call the plan and ask for the date.

Before Switching Plans

If you have other health-care coverage, such as Medicaid or retiree health insurance from an employer or a union, find out how these plans work with each Medicare plan. You will also want to find out all the facts about your coverage before dropping your extra insurance or switching between the different types of Medicare plans. If you drop your additional insurance when you change plans, you may not be able to get the same Medigap policy, or retiree health insurance, if you later want to return to Original Medicare.