Medicare Advantage And Supplement Plans In 2013
What Are Medicare Advantage Plans?
To help pay the costs that original Medicare does not cover, you can enroll in Medicare Advantage Plans (also called Medicare Part C).
Under Medicare Part C, the federal government contracts with private insurance companies to administer Medicare benefits. Advantage plans will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Many plans include additional benefits such as coverage for extra days in the hospital, vision, dental, hearing, preventive services like annual physicals, coverage of emergency services while traveling, or health and wellness programs, and Medicare prescription drug coverage (Part D).
Different Types Of Medicare Advantage Plans
The benefits, rules and premiums will vary depending upon the plan you choose. Your plan may have out-of-pocket costs or certain rules for how you can get medical services, e.g. that you need a referral to see a specialist. The most common types of Medicare Advantage plans are Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans or Private Fee-for-Service (PFFS) Plans. But no matter which you select, you are always covered for emergency and urgent care, and your policy must cover all services covered by original Medicare – except hospice care, which is always covered by Medicare.
Some advantage plans even offer additional health coverage at zero additional cost over your Part B premium!
You can join a Medicare Advantage plan:
- When you first get Medicare (Initial Enrollment Period)
- During certain times each year (Annual Enrollment Period)
- Under specific circumstances (Special Enrollment Period)
Insurance companies offer a wide variety of Medicare advantage plans – so before you join, make sure to compare the benefits and premiums of the plans that are available in your area!
What Are Medicare Supplement Plans?
Traditional Medicare (Part A and B) does not provide 100% coverage for medical expenses such as deductibles, co-payments, and co-insurance. Therefore supplement plans were designed to help pay the costs that Medicare does not cover. Supplement plans are also referred to as supplemental insurance, or Medigap. These policies are a type of private insurance that helps you pay for some of the costs that original Medicare does not cover.
The Difference Between Supplement and Advantage Plans
While advantage plans practically replace your Medicare plan, a Medigap policy supplements your original benefits. If you decide to get additional coverage with a supplement plan, Medicare will first pay its share of the approved amounts for your covered health care costs, and then your supplemental insurance will pay its share. You as the enrollee are still responsible for any co-payments as described in the plan’s summary of benefits.
Medigap is regulated by Federal and State Laws in order to protect you as a consumer and have to be clearly labeled as ‘Medicare Supplement Insurance’. Any insurance company licensed in a state may sell them. The policies are standardized for each state, and must follow federal and state laws. In most states you can select between ten standardized plans identified by the letters A through N. A policy only covers one beneficiary, so you and your spouse need to buy separate policies.
Supplemental plans are not allowed anymore to include prescription drug coverage, so you need to enroll in a Prescription Drug Plan (Part D) if you want to be covered. They also generally don’t include vision or dental care, hearing aids or eyeglasses, while some advantage plans may offer those kind of benefits, either included or optional.
Attention: While each standardized Medigap plan must offer the same basic benefits, no matter which provider is offering it, the insurance companies are free to set their own premiums. This means, costs may vary between companies, and you should always compare quotes for Medicare Supplement plans!