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How Good Is Your Medicare Health Insurance Coverage?

Medicare health insurance is generally designed to offer some coverage for hospitalization and routine health care, but it does not offer complete coverage for most services. In some cases, health care services you may need or want might not be covered at all, or may be covered only in limited circumstances.

Another consideration for Medicare beneficiaries is that not every health care provider accepts Medicare insurance. There is no requirement that doctors or hospitals accept Medicare. Many do, however based on recent and proposed changes in Medicare payment to providers, some doctors and hospitals are limiting the number of Medicare patients they’re accepting, and some providers have said that they will no longer accept Medicare.

When you enroll in Medicare, it’s important to decide how much you want to stay with your current doctor(s), hospital and/or pharmacy. Don’t make assumptions about your health care providers. You may need to ask each provider you see whether or not s/he accepts Medicare. If your provider does not accept Medicare, you may need to ask for a referral to another provider who does accept Medicare, or cover your health care costs from that provider out-of-pocket.

If you’re enrolled in traditional Medicare Part A and Part B, you can choose your health provider. Assuming your provider accepts Medicare, you can see the doctor(s) you want to see and receive services at your choice of hospitals that participate in the Medicare insurance program.

If you’re enrolled in a Medicare Advantage plan, you may have to choose your doctor(s), hospital(s) and pharmacies based on a list of participating providers who have been approved by your Medicare Advantage plan provider. In this way, Medicare Advantage plans are much like a health maintenance organization (HMO). If you choose to go out of your Medicare Advantage provider network, you could end up paying most or all of the costs associated with your care by yourself.

In short, not all health care providers accept Medicare, and not all services are covered. With traditional Medicare Part A and Part B coverage, you can purchase additional Medicare Supplemental Insurance to fill in some of the coverage gaps. With Medicare Advantage plans, some of these gaps are already filled in, but you may pay extra premiums with these plans, or you may find a limited network of health care providers whose services are covered by your Medicare Advantage plan.

Medicare Advantage Plan v. Medicare Supplement: Which One Is Right?

Medicare InsuranceIf you are new to Medicare, or will be joining the ranks of the Medicare-eligible in 2011, you may not know much about Medicare, Medicare Advantage Plans and Medicare Supplemental Insurance, also known as Medigap.  In addition, you’ll probably want to take a crash course in Medicare Part D plans, just to be on the safe side.

Traditional Medicare coverage is designated as Medicare Part A and Medicare Part B.  Part A coverage, which pays for hospitalization, has no additional premium, provided that you are age-eligible for Medicare.  Part B coverage has a premium attached to it. In 2010, the monthly premium was about $111, and is deducted from your monthly Social Security check, Railroad Retirement or Office of Personnel Management payment. If you receive none of these payments, you’ll get a quarterly bill in the mail for your Part B premiums.

You can choose some other Medicare options, including a Medicare Advantage Plan (Medicare Part C), an optional Medicare Part D plan for prescription drug coverage, and a range of Medicare Supplemental Insurance plans, collectively known as Medigap insurance.  Medicare Advantage plans take the place of Medicare Part A and Part B coverage and operate much like an HMO plan does.  Medicare Advantage plans generally offer some additional coverage that traditional Medicare plans do not.

You may also be required to enroll in a Medicare Part D plan if you choose to go with Medicare Advantage coverage.  With Medicare Advantage, you’ll still pay your Medicare Part B and Part D premiums. You may also have to pay additional premiums for a Medicare Advantage plan, depending upon the level of coverage you choose.

You can also choose to enroll in one or more Medicare Supplemental Insurance plans. Medigap plans are designated by letter (e.g., Medigap A, Medigap B, etc.) Each letter plan offers a different level of coverage but all Medigap letter plans are the same, regardless of the insurer that provides them. For example, all Medigap A plans have identical coverage; all Medigap B plans also have identical coverage, etc.) Insurers are not required to offer all Medigap insurance plans, and the premiums among insurers can vary.

Medigap supplemental insurance is designed to provide coverage for certain services that Medicare Part A, Part B and/or Part D don’t pay for, or don’t cover completely.  To take advantage of a Medigap insurance plan, you must be enrolled in both Medicare Part A and Part B. You will pay additional premiums for these services to a private insurance provider, and the additional insurance is strictly optional.  Many Medicare beneficiaries choose not to buy supplemental coverage either because they don’t need it or can’t afford it. Also, each recipient must have his or her own Medigap plan. Your Medigap insurance will not provide benefits to your spouse.

Since each beneficiary’s situation is different, your best strategy is to read all information about Medicare prior to enrolling in a plan. When you become eligible, you will receive a Medicare information booklet in the mail. This document has all of the basic information you’ll need about Medicare. You can also visit the Medicare Web site if you have Internet access to find out more information about Medicare coverage, Medicare Advantage plans and Medicare Supplemental Insurance.

Choose the insurance options that offer the best combination of coverage and cost, based on your income, your current health, and the coverage you’re likely to need in a given year. As you age, you may want to review your coverage and make changes to meet your evolving health needs.

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