So, you’ve decided that you need to look at Medicare (or, just as likely, someone has reminded you that you have to look at Medicare programs because if you don’t look at them soon, it’s going to be a problem)… So, where do you begin?
The most basic decision that you need to make is whether you want to participate in Original Medicare (Also known as Part A and Part B), or if you want to instead choose to enroll in a Medicare Advantage Plan, which is a Medicare-approved plan that is administered by a private health insurance company.
At its most basic level, Medicare Part A is government sponsored insurance for Hospital stays, while Medicare Part B is government sponsored insurance for Medicine and Medical supplies. There is some overlap between Part A and Part B under particular circumstances, but these are the exception rather than the rule.
In contrast, Medicare Advantage (MA) plans are private health insurance plans that mirror the government programs for both Part A and Part B combined into one plan. In many ways, these plans are very similar to either a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan that you may be familiar with through your employer or if you have purchased private insurance on your own.
The difference between these traditional health insurance plans and a Medicare Advantage Plan is that they have to follow basic guidelines to be approved by Medicare and must, at a minimum, provide basic coverage that is at least as comprehensive as the Medicare coverage for certain illnesses. Like traditional HMOs and PPOs, Medicare Advantage Plans offer choices about how much and what type of coverage you receive, and also offer plans that have different costs associated with them.
For example, HMO style MAs typically require you to choose a primary physician who follows your medical care and refers you to specialists within the HMO network as needed. Your coverage, other than for emergencies or urgent care situations typically needs to be within the HMO system, or you may have to pay higher or even all of the costs of treatment, depending on your plan’s rules. For following these guidelines, HMO-style plans are generally less expensive then PPO-style plans.
PPO style MAs typically allow you to seek coverage wherever you choose, but provide a discount if you work within the PPO network to receive discounted costs. Services provided outside the network are typically covered, but at a higher cost to the patient. Both HMO and PPO Medicare Advantage Plans require the person being covered to pay a monthly premium along with the monthly premium for Part B, when Original Medicare Part A does not usually have any cost.
The next choice that must be made is whether to get a Medicare prescription drug plan, also known as Medicare Part D. This coverage has a standard monthly premium to it when purchased with Original Medicare. When purchased with a Medicare Advantage plan, it may either be included as part of the Medicare Advantage Plan, or may require paying an additional monthly premium, depending on the specific MA plan chosen.
Ultimately, to choose what Medicare coverage to take, you need to consider what each of the plans offer, the costs (if any) for using them, including monthly premiums, coinsurance, and copayments, which Medicare Advantage plans are offered in your area, and whether doctors you see operate within the networks of the plans you are considering. Finally, you must consider how the different plans you are choosing work together and whether there are any particular enrollment periods or penalties.
Yes, there is a lot here, but we’ll take a closer look at each of these areas in upcoming blogs. Also, you can learn more here on this website, or by visiting our sister sites at MedicareWire.com.