subject: How To Select The Right Medicare Plan [print this page] Just deciding which way to go when choosing from the combination of different types of healthcare coverage is confusing for many people eligible for Medicare. For most people, having choices is a very good thing. But what about when you have thousands of plans to choose from?
When it comes to this program, you have nothing but choices. Depending upon your circumstances, you may want to stay with traditional coverage, or Parts A and B. If you choose this path, you'll probably want to get a Part D (prescription drug) plan, too, to ensure your medications are covered. Or, you might be more interested in an Advantage plan, which can combine traditional coverage with drug coverage and other benefits. You also may be interested in even more coverage, such as that offered through a Medigap (supplemental) plan.
Fortunately, help is available. A Medicare advisor offers education on available these programs, answers questions, and offers detailed plans of action to get the most out of your insurance choices. You also should know the basics beforehand.
Traditional Coverage
Parts A and B, also known as traditional or original coverage, have been around since 1965. Part A is free to most people who have worked and paid Medicare taxes for at least 10 years and provides people with inpatient hospital coverage. Part B, which costs most people $96.40 in 2009, covers outpatient medical expenses.
People who have traditional coverage can see any doctor they want in any facility they want without a referral, as long as that doctor or facility accepts patients with this coverage, but traditional benefits are limited.
Not only does traditional coverage not cover most outpatient prescription drugs, if a beneficiary uses their coverage frequently enough, it can get very costly. That's why we also have Advantage and Part D plans available.
Advantage Plans
Advantage, also known as Part C, combines Parts A and B in one plan so you can get your Part A and Part B coverage in the same place. Advantage plans also often include prescription drug coverage and other benefits not commonly found under traditional coverage, such as vision and dental services.
This program works just like private insurance - you have different types of plans to choose from depending upon what type of provider access you want (for example, health management organizations (HMO), preferred provider organizations (PPO), and more) and what health conditions you have or prescription drugs you take. You also can choose from a number of different levels of coverage. All Advantage plans must offer at least as much coverage as that offered under traditional coverage. If they offer prescription drug coverage, it must meet minimum Part D standards as well.
Part D
Part D is prescription drug coverage. Like Advantage, Part D is offered by private companies who are reimbursed for providing healthcare coverage. Also like Advantage, a minimum amount of coverage is required for a plan to qualify as a Part D plan and many different plans, some with different levels of coverage, are offered throughout the United States. Part D plans are best for people who use prescriptions, but don't need to see their doctors often.
Medigap
Medigap, or supplemental plans, is sold by private companies to fill the "gaps" in traditional coverage. This includes the cost of deductibles, co-payments and coinsurance. It also may cover other services that other coverage does not insure. In 2009, there are 12 Medigap plans - A through L.
Although this may offer some additional coverage if an individual chooses to keep traditional coverage, you can't buy this plan if you have Advantage. Because most Advantage plans offer better coverage and frequently more benefits than Medigap, having both is usually unnecessary. You can have both Medigap and Part D, but it may be more expensive to do this than simply purchasing an Advantage plan instead.
Comparing And Contrasting
It's no wonder that people are confused. There are thousands of plans available throughout the United States, and an average of 40 Advantage and Part D plans in any given area.
This is where a Medicare advisor can come in handy. With so many options in just one area, choosing a plan might feel like throwing darts at a board. Using Medicare assistance services can help you narrow down your choices so you know which combination of coverage will work best for you and which plans will give you the best and most affordable coverage for your needs.
