Medicare Plan Options

by Steve Wilson · 0 comments

Original Medicare, Medicare Advantage, and Medicare Supplement plans

Although similar in name, these three Medicare coverage options meet your health care needs differently. Take a close look at each plan’s particulars:

Original Medicare

Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with permanent kidney failure treated with dialysis or a transplant.

Original Medicare includes two parts:

  • Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility
  • Part B covers doctors and outpatient hospital services

Original Medicare pays for many health care services and supplies, but it doesn’t cover all of your healthcare costs. Also, drug coverage when not in the hospital is very limited. That’s why most people with Original Medicare carry additional Medicare coverage from a private insurance company – at an added premium cost.

Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage plan instead.

Medicare Advantage

Medicare Advantage health plans provide an alternative to Original Medicare. Most Medicare Advantage plans feature prescription drug benefits, fixed costs, limits on out-of-pocket expenses, and worldwide coverage for emergency and urgent care. Several different kinds of Medicare Advantage plans are available.

  1. Medicare Advantage Health Maintenance Organization (HMO) plans   –Save money with basic coverage

    • Affordable, fixed out-of-pocket costs make it easy to budget for expenses
    • Choice of a primary care physician from our list of approved doctors
    • Referrals required to see other providers (unless it’s an emergency)
    • Most include prescription drug coverage
  2. Medicare Advantage Preferred Provider Organization (PPO) plans   –Pay a little more for extra choices

    • You don’t need to select a primary care physician (PCP); you can choose a doctor who accepts Medicare assignment whenever you need care
    • Enjoy better benefits and lower co-payments if you visit network providers.
    • No referrals needed
    • Most include Prescription drug coverage
    • Some plans also offer dental, vision, and nutritional supplement benefits
  3. Medicare Advantage Private Fee-for-Service (PFFS) plans   –When freedom to choose is most important

    • See any doctor, hospital, or healthcare provider who accepts Medicare’s payment and plan providers payment terms and conditions
    • No referrals or plan networks
    • Limits on out-of-pocket expenses
    • Most include prescription drug coverage

A PFFS plan with a Medicare contract available to anyone enrolled in both Part A and Part B of Medicare through age or disability.

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept the terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept the payment terms and conditions, they may choose not to provide health care services to you, except in emergencies.

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