• Medicare Information
• Medicare Plan Options

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Medicare Plan Options

Original Medicare

Medigap (Supplement) Policies

Medicare Advantage (MA) Plans

Prescription Drug Plans

Medicare beneficiaries have many plan choices. How can you tell which plan is best for YOU?

The best place to start is to understand what is covered under Original Medicare. Then, based on your health needs, provider flexibility and monthly budget, you can decide which type of plan works for YOU.

Click on what to consider when Choosing a Medicare Plan for some helpful hints.

Original Medicare

Original Medicare is a fee-for-service plan managed by CMS. You can go to any licensed provider that accepts Medicare. Original Medicare has two parts:

• Part A covers hospitalization, skilled nursing facilities, hospice care, and some home health care. Most people don’t pay a monthly premium for Part A, but there is an annual deductible.
• Part B covers doctor visits, outpatient services, and supplies. With Part B, you must pay a monthly premium and annual deductible.

Original Medicare covers only 80% of some medical costs. Prescription drugs, and routine eye, hearing and dental care are not covered at all. That’s why many people increase their health insurance by purchasing a Medigap or Medicare Advantage Plan as well as a Prescription Drug Plan.

Medigap (Supplement) Policies

Medigap (Supplement) Policies are offered by private insurers.

• They generally cover the out of pocket coinsurance, copayments, and deductibles that a Medicare beneficiary would otherwise have to pay themselves.
• There are 12 plan options (plans A through L) and each varies by the amount payable monthly premiums and the extent of coverage.
• Medigap premiums become more expensive as you get older and many do not include prescription drug coverage.

Medicare Advantage (MA) Plans

Medicare Advantage (MA) Plans are also offered by private insurers and typically feature more generous coverage and lower out-of-pocket expenses than do the Original Medicare and many Medigap Plans. There are three types of MA Plans:

• Health Maintenance Organizations (HMO) are the most restrictive of the MA Plans. You typically select a primary care physician from the Plan’s network who coordinates all aspects of your care. You usually need a referral for specialty care, testing, and hospitalization. If you see providers outside of the network, or without a prior referral, you likely will have to pay the bill yourself.
• Preferred Provider Organizations (PPO) are also based on a network of providers but do not require referrals. In a PPO, you can see any provider that accepts Medicare, but your out-of-pocket expenses can be higher if the provider does not participate in the PPO network.
• Private Fee-For-Service (PFFS) Plans offer better benefits than Original Medicare and many Medicare Supplements with NO network restrictions and NO referrals. A Medicare Advantage PFFS plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can download the plan’s Terms and Conditions.

Prescription Drug Plans

Prescription Drug benefits are available through Medicare Part D as standalone policies; however, many MA Plans have Part D built in so you have the convenience of one source for all of your health care coverage.