What Is Medicare?
Medicare refers to four parts – A, B, C, and D. Parts A and B are medical coverage associated with traditional Medicare. Part C is Medicare Advantage plans which are different than traditional Medicare. Part D covers prescription drug plans.
Traditional Medicare has certain copays and coinsurance that you have to pay out of pocket. There is a group of insurance policies called Medicare supplements or Medigap policies that will pay all or part of the portion you have to pay out of pocket. With traditional Medicare there are no networks and no preauthorization for treatments. You have coverage anywhere in the US.
All Medicare drug plans are offered by insurance companies. Medicare has broad guidelines the plans must meet, but there is a wide range of premiums and formularies. To find a plan that fits you, go to medicare.gov and input your current medications. The site will show you how each of your drugs is covered by each plan and an estimated annual cost.
Medicare contracts with insurance companies to provide advantage plans. Medicare pays a premium of several hundred dollars per month for each member in an advantage plan. In return the insurance company has total responsibility for its members. Most advantage plans include drug coverage that is the same as Part D drug plans. The plans must follow Medicare guidelines, but they can require members to use a network of providers and can require prior approval for certain tests and procedures.
To enroll in an advantage plan, you must be enrolled in Medicare parts A and B. Premiums range from 0 to over $110 per month. There are copays and coinsurance you must pay out of pocket. The Medicare supplement policies that work with traditional Medicare cannot be used with the advantage plans.
Which system, traditional Medicare, or Advantage plans should you choose? Traditional Medicare gives you the most freedom to go anywhere in the country to any doctor who will accept Medicare. Advantage plans have networks and require preauthorization for certain procedures.
If you need help deciding which is best for you, click the button below, and I will be happy to work with you to determine which is best for you.