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Golden Inspirations |
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Home  In this Issue Senior and Senior News Original Medicare or a Medicare Private Health Plan?
Original Medicare or a Medicare Private Health Plan? Things to Consider
It's fall again, the season when health insurance companies begin marketing Medicare private health plans. Each year, from November 15th to March 31st, everyone with Medicare has the option to change their Medicare coverage, either to Original Medicare or to one of the private health plans known as Medicare Advantage plans. The vast majority of people who have Medicare stick with Original Medicare-the traditional fee-for-service program run by the federal government-which offers access to virtually any doctor, specialist and hospital in the country.
Many insurance companies advertise Medicare private health plans that have low premiums or offer special benefits. These plans must cover at least the same inpatient (Part A) and outpatient (Part B) services covered by Original Medicare. Private health plans may also offer additional benefits, like dental or vision care, that Original Medicare does not cover. Many offer Medicare prescription drug coverage (Part D) as part of their benefits packages. Keep in mind, however, that there is much more to consider when choosing how to get your Medicare health coverage. Regardless of what health plan you choose, most people will be locked into that plan from March 31st until the end of the year.
If you sign up for a Medicare private health plan, you will get your Medicare benefits through the plan. You must follow the private health plan's rules and will most likely incur high out-of-pocket costs if you do not. Some of the most commonly offered types of Medicare private health plans are health maintenance organizations (HMO), preferred provider organizations (PPO), and private fee-for-service (PFFS) plans.
Before you sign up for a Medicare private health plan, make sure you can use the doctors, specialists and hospitals that you prefer. Private health plans restrict you to certain providers, usually from their provider network. Often, you need a referral from your primary care doctor before you can see a specialist. Your doctor may also have to follow certain rules, like seeking the private health plan's approval before prescribing a treatment or admitting you to the hospital. These limitations might make it difficult for you to get urgent care, or care that you need when you travel outside your private health plan's network.
Private health plans can be costly, so make sure you can afford a plan before you join it. Make sure you know all your private health plan's costs, since some charge higher copays for certain types of care, like cancer care. Also, understand the rules in advance. If you do not follow the private health plan's rules you may have to pay up to the full cost of the service. Keep in mind that private health plans can change their rules, provider networks and costs every year.
If you choose Original Medicare, it is best to also have supplemental coverage which helps cover health care costs that Medicare does not cover. If you do not have a retiree health plan to supplement Original Medicare, you can buy a supplemental plan known as a Medigap plan. You can also buy a standalone Medicare private drug plan (PDP) that works with Original Medicare to give you Medicare prescription drug coverage (Part D). Low-income people with Medicare may be eligible for Medicare Savings Programs that help with the out-of-pocket costs of Original Medicare.
To read more about how to choose a Medicare health plan, Medicare prescription drug coverage, and supplemental coverage, including Medigap plans and Medicare Savings Programs, log on to the Medicare Rights Center website at http://www.medicarerights.org/help. html. Medicare Interactive is a resource provided by the Medicare Rights Center, the largest independent source of health care information and assistance in the United States for people with Medicare.
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Heidi Kreamer
Medicare Rights Center
520 8th Ave., North Wing, 3rd Floor
New York, NY 10018
212-204-6233
www.medicarerights.org
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