A Brief Look at Medicare

Medicare covers many of your health care needs. Today’s Medicare is working with private companies health plans provide different ways to get your health care coverage in the Medicare program.Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare health plan choices include:

1.) Original Medicare Plan This is a fee-for-service plan that covers many health care services and certain drugs. You can go to any doctor or hospital that accepts Medicare. When you get your health care, you use your red, white, and blue Medicare card.

The Original Medicare Plan pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs that you must pay, like coinsurance, copayments, and deductibles. These costs are called “gaps” in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. You can also add prescription drug coverage by joining a Medicare Prescription Drug Plan.

2.) Medicare Advantage Plans – Available in many areas. If you have one of these plans, you don’t need a Medigap policy. These plans include:

• Health Maintenance Organizations (HMO),
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

These plans may cover more services and have lower out-of-pocket costs than the Original Medicare Plan. Some plans cover prescription drugs. In some plans, like HMOs, you may only be able to see certain doctors or go to certain hospitals to get covered services.

Medicare Prescription Drug Plans – stand-alone plans that add prescription drug coverage to the Original Medicare Plan and to some Medicare Cost Plans and Medicare Private Fee-for-Service Plans.

Deciding How to Get Your Medicare Benefits

You can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices. In most cases, when you first get Medicare, you are in the Original Medicare Plan. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A (hospital), Part B (medical), and often Part D (prescription drugs) coverage. You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall. There are things you should consider to help you meet your needs.

Things to Consider for Each Option:

Cost: What will you pay out-of-pocket, including premiums?

Benefits: Are extra benefits and services, like eye exams or hearing aids covered? (These may be covered by some plans.)

Doctor and hospital choice: Can you see the doctor(s) you want? Are they accepting new patients? Do you need a referral to see a specialist? Can you go to the hospital you want? Do you pay less to go to certain doctors or hospitals?

Convenience: Where are the doctors’ offices? What are their hours? Is there paperwork?

Convenience: Where are the doctors’ offices? What are their hours? Is there paperwork?

Prescription drugs: What will your prescription drugs cost under the plan’s formulary (list of covered drugs)? What are your drug needs?

Travel: Do you spend part of each year in another state? Will the plan cover you there?

Pharmacy choice: What pharmacies can you use?

Quality of care: Quality of care varies among plans, doctors, hospitals, and other health care providers. Giving good quality health care means doing the right thing, at the right time, in the right way, for the right person—and getting the best possible results. Quality information to help you make the best choices for your well-being is available at www.medicare.gov on the web, or by calling 1-800-MEDICARE (1-800-633-4227).

Information provided courtesy of Medicare.gov. For more information about their plans and policies visit their website or call the toll free number listed above.