While Medigap plans are supplements to Medicare, there is another way to get coverage.
While Medicare Supplement plans help with deductibles and other expenses not paid by Original Medicare, they do not cover services if Original Medicare does not cover them. For example, they do not cover long-term care, dental care, or eye glasses.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare, which pays these companies to cover your Medicare benefits. They can offer many more services not covered by the aforementioned plan.
What do they cost?
This depends on the type of coverage you want. In addition to your Part B premium, you usually pay one monthly premium for the
services included in a Medicare Advantage Plan. Each Plan has different premiums and costs for services, so research is important here.
What do they do?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care; original Medicare will cover hospice. There are several types of these plans, as follows:
• Health Maintenance Organization (HMO) plans—In most HMOs, you can
only go to doctors, other health care providers, or hospitals in the plan’s network,
except in an urgent or emergency situation. You may also need to get a referral
from your primary care doctor for tests or to see other doctors or specialists.
• Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you
use doctors, hospitals, and other health care providers that belong to the plan’s
network. You usually pay more if you use doctors, hospitals, and providers outside
of the network.
• Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original
Medicare in that you can generally go to any doctor, other health care provider,
or hospital as long as they accept the plan’s payment terms. The plan determines
how much it will pay doctors, other health care providers, and hospitals, and how
much you must pay when you get care.
• Special Needs Plans (SNPs)—SNPs provide focused and specialized health care
for specific groups of people, like those who have both Medicare and Medicaid,
live in a nursing home, or have certain chronic medical conditions.
• HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow
you to get some services out-of-network for a higher copayment or coinsurance.
• Medical Savings Account (MSA) plans—These plans combine a high-deductible
health plan with a bank account. Medicare deposits money into the account
(usually less than the deductible). You can use the money to pay for your health
care services during the year. MSA plans don’t offer Medicare drug coverage. If
you want drug coverage, you have to join a Medicare Prescription Drug Plan.
Most Medicare Advantage Plans offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.
Plan benefits can change from year to year. Make sure you understand how a plan works before you join.
When comparing the benefits and costs of plans in your area, be sure to take these key factors into consideration:
- Monthly premiums
- Anticipated costs of health care and hospital services you use often
- Restrictions on doctors, hospitals, and pharmacies
- Expected costs of prescription drugs that you require regularly
- Maximum out of pocket amounts
How do I get one?
Here are some links to assist you. I am not recommending one plan over another; please do research. I have been looking at some of these plans and they confuse me a bit. I would recommend that you speak to a rep from one of the companies to see if you feel comfortable will shelling out more shekels to pay for one of these.
Again, I cannot stress enough that the more plans you compare, the better off you will be.