Tag Archive for part c

ElizabethGHoward | 02/10/2011
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Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Both “Medigap” and Medicare Advantage plans are often referred to as “supplemental insurance” plans in Medicare articles and literature.  This language is confusing and somewhat misleading. Do you understand the difference?

Nicknamed “Medigap,” it is technically the only real “supplemental insurance”; its formal name is Medicare Supplemental Insurance. Only people enrolled in traditional Medicare can use a supplemental insurance plan.

Medigap is NOT a government run plan. Medigap is private insurance. You can buy it to defray some or most of your out-of-pocket costs. These might include:

  • The hospital deductible for Part A, which is currently $1,100 for each hospital benefit period.
  • Part B costs such as the percentage you pay for doctor’s visits and outpatient services.
  • The costs of emergencies up to plan limits you incur when traveling overseas.
  • Other costs as defined by the plan.

 

There are 10 types of medigap policies, and they are legally standardized, which means that the benefits you get are the same, regardless of who sells them to you.

However, that does not mean you will receive the same price from each insurer so it’s a good idea to check around. To compare the benefits in each Medigap plan, enter your zip code at Medicare Solutions.com to get started.

Medicare Advantage is an umbrella name for a VARIETY of private health plans which include HMOs, PPOs, PFFS (Private Fee For Service plan.)

Medicare Advantage, called “Medicare Part C” is an alternative to the traditional Medicare program. Those who enroll in Medicare Advantage may NOT purchase a Medigap plan or a stand-alone prescription drug plan.

Each Medicare Advantage plan covers all the same benefits as traditional Medicare (called “Part A” and “Part B”), but the plans operate on the copayment system and may offer extra benefits. Sometimes the copayments are lower than traditional Medicare, and sometimes not. Each plan is different.

For example, some plans may include vision and hearing services, and include prescription drug coverage at no additional cost. However, most plans will require you to go to in-network doctors, or to pay high co-pays if you go out of network.

To compare Medicare Advantage plans, go to Medicare Solutions.com and enter your zip code to begin.

Category: Medicare Advantage, Medicare Tips, Supplement Medigap | Tags: , , , , , , , , , , , , ,
Bill Stapleton | 02/19/2010
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Cigna PFFS Plan to Close

Effective February 1, 2010, Cigna is closing their CIGNA Medicare Access PFFS plans to OEP enrollments.

CIGNA will still accept clients enrolling during their individual election period (those aging in to Medicare or newly eligible to Medicare) and those with a Special Enrollment Period. Current clients who have CIGNA Medicare Access PFFS will not see a change in their 2010 benefits. They will continue to have coverage for the entire year. There will be no changes in benefits due to this decision.

Please note this does not effect plans such as CIGNA Medicare Rx, CIGNA Medicare Select Plus Rx, or any of CIGNA’s other medical or pharmacy plans.

Category: Medicare News | Tags: , , , , ,
Annie Finneran | 03/25/2009
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Choose the Medicare plan that’s right for you

When your Original Medicare Plan kicks in, it’s time to make some other decisions relative to your health. Being informed about your options can help you make a better decision. Medicare is a national health insurance program for individuals ages 65 or older, individuals under the age of 65 who have been declared disabled, or individuals with end-stage renal disease (ESRD). There are approximately 43 million elderly and disabled Medicare-eligible beneficiaries in the U.S. today.

Medicare is broken down into 4 parts: Medicare Part A, Medicare Part B, Medicare Part C or Medicare Advantage, and Medicare Part D.

Medicare Part A is the Original Medicare. You are automatically enrolled in the Original Medicare Plan which is managed by the federal government. Medicare Part A is the hospital insurance. It covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. You don’t usually have to pay a premium for Part A because the individual paid Medicare taxes while working.

Medicare Part B is a medical insurance offered by the federal government to eligible beneficiaries. Medicare Part B covers physician services, non-physician services, diagnostic tests, lab services, and ambulance transportation. Preventative care is also covered by Part B. Most people have to pay a premium for Part B.

Medicare Part C, or Medicare Advantage is a combination of Part A and Part B. Medicare Advantage plans are private health plans provided by private insurance companies. Part C is an alternative to Original Medicare and offers extra benefits. Part C plans include Medicare Health Maintenance Organization (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee for Service (PFFS), and Medicare Medical Savings Account (MSA).

Medicare Part D is a prescription drug coverage that helps pay for outpatient prescriptions drugs. You can either add Part D to your Original Medicare Plan or join an HMO or PPO that includes Part D coverage.

Just like choosing health insurance, Medicare insurance should be tailored to your needs. You can choose a plan based on premiums and out of pocket costs, additional benefits, whether referrals are needed, and whether the doctor you currently have is in network or out of network. After you have researched and gathered all the information necessary to make an informed decision, it is then time to choose from a variety of plans that suit your needs.

Category: Medicare Advantage, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , , , ,
Annie Finneran | 01/16/2009
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Medicare Buzz Words Everyone Should Know

Medicare, like standard health insurance can be very confusing, especially if you don’t know what half the words mean.

  • Part A: Hospital insurance- helps pay for hospice care, inpatient hospital care, and skilled nursing facility care. Individuals are entitled to Part A if they contributed payroll taxes for 10 years or more while they worked.
  • Part B: Supplementary Medical Insurance- helps pay for physician services, outpatient care, preventive services, x-rays, diagnostic tests, and mental health services. It is funded primarily by premiums.
  • Part C: Medicare Advantage- provides care through managed care plans. Plan C provides Parts A, B, and D benefits.
  • Part D: Prescription drug plan- enrollment is voluntary and is provided by private prescription drug plans or Medicare Advantage prescription drug plans.
  • Medigap- refers to private supplemental health insurance plans sold to Medicare beneficiaries. It covers medical expenses that may not be covered by the Original Medicare plan.
  • Original Medicare- a fee-for-service plan that covers many health care services and drugs but doesn’t pay for all health care costs. There are costs such as coinsurance, copayments, and deductibles that you must pay. It includes Medicare Part A and Medicare Part B.
  • Monthly premium- a monthly payment to Medicare, an insurance company, health care plan or drug plan for health coverage.
  • Annual deductible- The amount you pay for medical services and prescriptions before your health insurance plan or Medicare plan kicks in and begins to pay.
  • Coinsurance- The amount you may be required to pay for services after you pay any deductibles.
  • Copayment- an amount you pay for services such as a doctor’s visit or specialist visits regardless of whether you have fully paid your deductible.

These are just some of the terms you should be familiar with when you are dealing with your Medicare plan or when you are choosing a Supplemental Medicare plan. They can help you to better understand the process and make an informed decision about the right plan to choose. Other ways to stay informed is to talk to your health insurance representative or carrier and stay current with insurance news.

Category: Medicare Tips | Tags: , , , , , ,