What You Need to Know
Medicare is a federal program that provides low-cost health insurance for people 65 or older, people under 65 with certain qualifying disabilities, or people of any age with end-stage renal disease (kidney failure). It has several different parts that cover specific services:
- Part A: hospital insurance
- Part B: medical insurance
- Part C: health plans run by Medicare-approved private insurance companies (also known as “Medicare Advantage Plans”)
- Part D: prescription drug coverage
So whether you’re turning 65 or have become eligible for Medicare due to disability, or even if you’re just making your annual health plan choice for the coming year, determining which type of health insurance policy makes sense for your unique situation is a critical decision.
If you are eligible for Medicare now, choosing which type of plan makes the most sense for you is based on a number of key factors:
- Your health today: Are you relatively healthy for someone your age, or do you have multiple chronic conditions? Different plans will afford different levels of cost sharing (what you have to pay out of your own pocket), so this is important to keep in mind. In your current situation do you see specialists as well as a primary care physician? Start by making a list of all the medical professionals you currently use, and we can help you find out what plans they currently accept.
- Prescription drugs you now take: Make a list of the medications with their name, daily dosage, and the pharmacy you use to fill your prescriptions. We will work with you to determine which plans will cover your specific prescriptions with the least total cost to you.
- Travel: If you own a second home, or if you spend winter months away from your primary home, it is important to make sure that the plan you select will be accepted where you spend your time.
Medicare Advantage Plans
Medicare Advantage Plans (like HMOs and PPOs) are health plan options offered by private companies approved by Medicare. They’re part of the Medicare program, and are sometimes called “Part C.” When you join a Medicare Advantage Plan, you’re still in Medicare – it’s not a supplemental plan.
Features of Medicare Advantage Plans:
- Some require referrals to see specialists.
- In addition to your monthly Part B premium, usually you pay an additional monthly premium for the services included.
- Each plan can charge different out-of-pocket costs and have different rules for how you get services, so you should check the plans you’re interested in before you join.
- The plans provide all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage and must cover medically-necessary services.
- They often have networks, so you may have to see doctors who belong to the plan or go to certain hospitals to get covered services, or you may pay more.
- They generally offer extra benefits, and many include Part D prescription drug coverage.
- You don’t need to buy a Medigap policy.
- It may be a Health Maintenance Organization (HMO); Preferred Provider Organization (PPO); Private Fee-for-Service (PFFS) Plan; Medicare Medical Savings Account (MSA) Plan; or Medicare Special Needs Plan. You can learn more about these types of organizations and plans from the government booklets “Your Guide to Medicare’s Preferred Provider Organization (PPO) Plans,” “Your Guide to Medicare Private Fee-for-Service Plans,” and “Your Guide to Medicare Special Needs Plans (SNPs).”
As an independent agency, we work with a large number of insurance companies that offer both traditional Medicare policies as well as Medicare Advantage Plans. With our guidance you can be confident that your purchase will be the best plan for your particular needs.
Moscato & Associates and Foresters Equity Services are separate and unaffiliated entities.
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