Differences in Medicare Plans

Medicare is something you’ve heard about throughout your adult life. And if you’re approaching the age in which you can sign up, you’ve probably familiarized yourself with it a little bit more. Even if you’ve read just a few of our blogs, you’re pretty well-acquainted with Medicare. However, it’s one thing to know about Medicare, and what its basic functions are. But it’s a completely different thing to understand how Medicare will apply specifically to you.

That’s why The Best Senior Services (TBSS) is taking the time to explain the differences in Medicare plans so that you can spend less time worrying about what you need, and more time preparing for your needs.

Original Government Medicare (OGM)

The OGM plan is administered throughout the federal government. Within this plan, there are two parts: Part A and Part B. You’re probably familiar with both Parts, but for a quick refresher, let’s dive into what each offer.

Medicare Part A: Part A of your OGM plan is going to be hospital insurance. In other words, it covers in-patient hospital care, hospice care, nursing home care and more. You are eligible for Part A if you are at least 65 or if you have End-Stage Renal Disease (ESRD). For many Americans with Medicare, Part A is free. Well, kind of. Most people will get Part A for “free” if they (or their spouses) have been paying into Medicare taxes for a minimum of 10 years and/or have a specific number of quarters of coverage (QCs).

Now, this is where it gets tricky. According to Centers for Medicare and Medicaid Services, “the exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or ESRD.”

• Medicare Part B: Part B of your OGM plan is going to be medical insurance. In other words, it covers out-patient medical care. According to Medicare.gov, this includes “medically necessary services” — like those that are used to diagnose you and/or treat you for an illness — and “preventive services” — health care that prevents an illness, or detect it at an early stage, when its treatment will be most effective.

  Unlike Part A, everyone will have to pay a monthly premium for Part B. However, how much an individual is required to pay will vary from person to person. Many people believe that this is based upon your location or what state you live in, but it’s actually based upon your income.

• Medicare Part D (optional): Part D of your OGM plan is going to be prescription drugs. It is responsible for covering drugs that would otherwise be uncovered by Parts A and B.  Like Part B, individuals who have Part D will have to pay monthly premiums, as well as yearly deductibles, copays and the gap in coverage. Rates will also vary upon the individual.

  However, on the bright side, the federal government will fund 75% of the medication costs under Part D. According to Medicare.gov, how much you will owe on the coverage gap depends on:

• “Your prescriptions and whether they’re on your plan’s list of covered drugs,
• What ‘tier’ the drug is in,
• Which drug benefit phase you’re in,
• Which pharmacy you use,” and
• Whether you utilize Medicare’s “Extra Help” program for paying for your drug coverage costs.
• Medicare Supplement Plans (optional): Medicare Supplement plans, also known as Medigap, is designed to help individuals cover costs that otherwise would not be covered by their OGM (Original Government Medicare) plan. These costs could be along the lines of copayments, deductibles, or coinsurance. It is important to note that you may only enroll in a Medicare Supplement plan if you are enrolled in OGM, and no other Medicare plan.Medicare Supplement premiums are separate from Part B premiums, meaning the two must be paid for separately. Individuals with Medicare Supplement plans can pay for their monthly premiums through their private insurance provider.

Medicare Advantage (Medicare Part C)

As opposed to the Original Government Medicare plan, there is a Medicare Advantage plan that is offered to individuals. Also known as Part C, this plan is offered by private companies that have been approved by Medicare. Being a part of a Medicare Advantage plan will give you both Part A and Part B, as well as the optional Part D. However, an individual with Part C will be unable to enroll in Medigap.

Medicare.gov has laid out the different types of Medicare Advantage plans that you need to know about:

• Health Maintenance Organization plans. In most Health Maintenance Organizations (HMOs), your plan will have a network. Within this network, you will have a list of doctors, hospitals, or health care providers in which your plan will be accepted. When you go outside of this network, services will not accept your plan. However, this network is not abided by when you are in an emergency situation. This means that, if you are out-of-network, and you are in an urgent situation or in need of dialysis, you will be able to seek services.
• Preferred Provided Organization plans. Preferred Provided Organizations (PPO) allow you to pay less for specific services if you stay within your network. These services induce doctors’ visits, hospital visits and other health care services.
• Special Needs Plans (SNPS). SNPs includes unique health care for a limited group of people. This limited group includes people with both Medicare and Medicaid, those who live in a nursing home, and/or those who are living with chronic medical conditions.
• Private fee-for-Service plans. The Private fee-for-Service Plans (PFFS) allow you to go to just about any doctor, hospital and/or health care provider, just like you would be able to if you have the OGM plan. Your PFFS plan will help you determine how much it will be paying for these visits, and how much you will be paying when you go to these visits.
• Medical Savings Account plans. Your Medical Savings Account plan (MSA) will combine a bank account with a “high-deductible health plan.” Medicare will deposit money into this account, and you will be able to use it to pay for your health care services. However, drug coverage is not offered by MSA plan. You will have to get Part D in order to acquire prescription drug coverage.

Essentially, you will find that a Medicare Advantage plan will cover most of what the OGM plan will cover, with exception to the hospice care. With Medicare Advantage plans, you will be covered for all types of emergency care. The only way in which you will be unable to receive these services while out-of-network is if you are no longer in the country.

A benefit that Medicare Advantage offers, that is not offered by Original Medicare, is dental and vision care, as well as wellness programs.

One thing that is important to note is that there is no “right” or “wrong” Medicare plan. It’s just a matter of what is the best plan for you and your loved ones. Each Medicare plan has a lot of benefits that are available to you, so it is worth exploring what options are available to you based off of your current location.

When you’re more familiar with Medicare, you feel more at ease about signing up for your plan. And The Best Senior Services can help with that too. If you have any more questions about the differences within Medicare plans, don’t hesitate to contact TBSS today. Not only do we educate seniors about Medicare and other financial services, but we also connect you with local licensed agents who are more than happy to answer any of your questions and walk you through your options. You can get started with us by visiting our website or calling us at 855.979.8277 today.