TYPES OF MEDICARE PLANS
Part A
Medicare Part A is also known as hospital insurance. It primarily covers inpatient hospital care, skilled nursing facility care, hospice care and some home health services. Most people don’t pay a premium for Part A.
Part B
Medicare Part B, also known as medical insurance, covers a range of medical services and supplies including doctors visits, outpatient care, home health care and certain preventative services. Part B requires a monthly premium, which can vary based on income. Part A and Part B are also referred to as Original Medicare.
Part C
Medicare Part C is also called Medicare Advantage. This coverage services under parts A and B and reduces copay’s and coinsurance in many cases. In addition, Medicare Advantage plans cover things such as dental, vision, and hearing benefits. Most Advantage plans also cover Part D prescription drug coverage.
Medicare pays a fixed amount for your plan every month to the companies offering Medicare Advantage plans. Some plans also require a nominal monthly premium that you would be resoponsible for. Your budget, where you live, your medical needs, and your doctor preferences should all be taken into consideration before selecting a Medicare Advantage Plan.
Part D
The Prescription Drug Plan (Medicare Part D) helps to cover the cost of your prescriptions. It is often included with Medicare Advantage (Part C) plans. Stand alone Part D plans, are also available. Not everyone takes prescription drugs. However, if you decide not to enroll in Part D, there is a penalty per month from the time you first enroll in Medicare Part B until you finally enroll in a Part D plan, which will apply to your premiums as long as you have coverage.
A Health Maintenance Organization is a network of doctors and hospitals. With an HMO you choose a Primary Care Physician from a list of doctors in your network for your care. Most plans allow you to see a Specialist without a referral from your PCP. If you go outside the network, except for emergency care, you must pay for your own care.
Preferred Provider Organization Plans (PPO)
A Preferred Provider Organization plan may offer more options than an HMO. These plans have traditionally offered more flexible usage and selection of doctors and the ability to see doctors in other states. Both of these benefits are now embedded in HMO. A unique benefit of PPO plans is the ability to go outside the network to any provider without having to pay the entire cost yourself, but you will usually pay a larger share of the cost.
Special Needs Plans (SNP)
Special Needs plans are available for people who are eligible for both Medicare and the Medicaid assistance programs in Arizona, called AHCCCS. There are also special needs plans for those who live in nursing homes, a long-term care facility, or for those who have certain chronic diseases. We can help you determine if you qualify for one of these plans.
Medicare Supplement Insurance (Medigap)
Medicare generally covers 80% of medical costs. A Medicare Supplement plan covers the balance of the 20% not paid by Medicare depending on the plan selected. You will pay a monthly premium for the plan and will not receive a bill unless it is a service that Medicare does not cover. This plan allows you to see any doctor who accepts Medicare anywhere in the country. It is designed to cover expenses that Medicare Part A and Part B but not Part D.
Medigap plans are identified by a handful of plans from letters A thru N, each with different benefits, costs and premium amounts. Each plan must offer the same basic benefits no matter which company offers it. Part D Prescription Plans are not covered with Medigap plans so you will need a separate Part D Plan as well. It is not uncommon for your Supplement premium to go up 10% per year. It is wise to re-shop your Supplement every 2-3 years to make sure your monthly premium is in alignment with the current market premiums. You can reshop your Medigap plan anytime during the year – the annual election period does not apply to you.
