Over 65 & Medicare
Medicare covers many of your health care needs. Today’s Medicare is working with private companies approved by Medicare that provide different ways to get your health care and prescription drug coverage in the Medicare Program. The Medicare plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality.
Your Medicare & Medicare Advantage plan choices include:
Medicare Insurance Plans
The 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.
Medicare Advantage Plans
These are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare. With Medicare Advantage Plans:
- Some of the plans require referrals to see specialists.
- In many cases, the premiums or the costs of services (co-pays and deductibles ) can be lower than they are in Original Medicare or Original Medicare with a Medigap policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
- The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
- They often have a network, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
- They generally offer extra benefits, and many include prescription drug coverage.
- In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
- Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
- You don’t need to buy a Medigap policy.
Medicare Advantage Health Plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS) Plans
Medigap Policies
These are health insurance policies sold by private insurance companies to fill "gaps" in Original Medicare coverage. In general, with a Medigap policy:
- You get help paying for some of the health care costs that Original Medicare doesn’t cover.
- You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
- You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.
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