Types of Medicare Plans
Types of Medicare Plans
Do you know that there are different ways you can get your Medicare health and prescription drug coverage? You can choose Original Medicare. This is the traditional fee-for-service plan provided by Medicare. Or, you can choose Medicare Advantage (also known as Part C). You can also get Medicare prescription drug coverage to help cover some of the costs of your prescription drugs. AARP’s Medicare Question and Answer Tool is a starting point to guide you through the different Medicare plans. General
Q: A: There are different parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage) and Part D (prescription drug coverage). — Original Medicare
Q: A: Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows beneficiaries to go to any doctor or hospital that accepts Medicare, anywhere in the United States. Medicare will pay its share of the charge for each service it covers. You pay the rest, unless you have additional insurance that covers those costs. Original Medicare provides many health care services and supplies, but it doesn’t pay all your expenses. — Q: A: You get Part A and Part B of the Original Medicare plan when you’re automatically signed up for Medicare. To get drug coverage under Original Medicare, you must choose and join a Medicare-approved Part D private drug plan. — Q: A: It's easy if you receive Social Security retirement benefits: The Social Security Administration will automatically enroll you in Medicare when you turn 65. If you are under 65 and get disability benefits, the Social Security Administration will enroll you in Medicare after you have received benefits for 24 months. — Medicare Advantage Plans Medicare Part C
Q: A: Medicare Advantage, or Medicare Part C, is a privately run alternative to original Medicare. Medicare Advantage plans are sold by Medicare-approved private insurance companies and must cover the same health care services as original Medicare (except hospice care). — Q: A: Medicare Advantage plans must include both Part A and Part B. — Q: A: Medicare Advantage plans are available in most parts of the United States. To begin your search for a plan, use the Medicare Plan Finder at , or contact your local State Health Insurance Assistance Program (or SHIP) at www.shiptacenter.org. — Q: A: The private plans operate differently from original Medicare in several ways. - Q: A: If you have a Medicare Advantage plan, you cannot buy a Medicare Supplement Insurance or Medigap plan. — Q: A: Medicare Advantage plans cover all Medicare-covered services and must include both Part A and Part B benefits.— Q: A: Before you choose a Medicare Advantage plan, consider carefully the many options these plans offer. Begin by asking yourself the following questions. — Q: A: Medicare doesn’t automatically enroll you in a Medicare Advantage plan — you need to choose a plan and sign up directly. — Q: A: If your Medicare Advantage plan is ending at the end of the year, you can join another Medicare Advantage plan or enroll in original Medicare.— Q: A: You can change plans or join original Medicare once a year during the annual open enrollment period, from Oct. 15 through Dec. 7, and your new coverage will begin Jan. 1 of the following year. — Q: A: In 2017, most Medicare beneficiaries can choose from a variety of plans from at least six insurance companies. The plans may have different provider networks, cover different drugs at different pharmacies, and can charge different monthly premiums, annual deductibles, and copayments or coinsurance for hospital and nursing home stays, and other services. — Q: A: You must first enroll in original Medicare and then switch into the separate Medicare Advantage program, which is an alternative to original Medicare. — Prescription Drug Coverage Medicare Part D
Q: A: Medicare Part D drug coverage is sold by private insurance plans that set their own premiums, prescription prices and other charges that can vary from plan to plan. — Q: A: In the initial phase of Part D coverage, you pay roughly 25 percent of the plan's cost for the drug. When you and the drug plan have paid a total of $3,700 for drugs in 2017, you enter the coverage gap or doughnut During this second phase, you will pay no more than 40 percent of the plan's price for a brand-name drug and 51 percent for a generic drug. — Q: A: Only the amount you and your Part D plan have paid for covered drugs determines when you reach the coverage gap. — Q: A: You should receive a monthly statement from your plan showing your total out-of-pocket costs for covered prescription drugs and indicating if that amount puts you in the coverage gap or takes you out. — Q: A: The coverage gap or doughnut hole will gradually narrow, if the current law continues as scheduled, until in 2020 and beyond you will pay no more than 25 percent of the cost of any covered drug in the doughnut hole. — Q: A: The Medicare Part D doughnut hole will gradually narrow until it completely closes in 2020. — Q: A: Once the doughnut hole is closed in 2020, you will pay approximately 25 percent of the cost of your prescriptions until you reach the last phase or catastrophic coverage level. — Q: A: Yes, the catastrophic phase of the Part D benefit is permanent to help protect those people facing the greatest outpatient drug costs. — Q: A: The doughnut hole (or coverage gap) is part of the Medicare Part D drug benefit. — Medigap Medicare Supplemental Insurance
Q: A: Medigap or Medicare supplemental insurance is sold by private insurance companies and helps pay some of the health care costs original Medicare doesn’t cover, including some or most Medicare deductibles and coinsurance. — Q: A: Yes. Medigap and Medicare Supplemental Insurance are the same thing. — A: By law, Medigap insurers aren’t allowed to sell more than one Medigap plan to the same person. — Q: A: In most states, 10 standard categories of Medigap policies are available — labeled A, B, C, D, F, G, K, L, M and N. — Q: A: Probably one of the most critical factors is timing. You have a one-time six-month Medigap open enrollment period that starts the month of your 65th birthday and you are enrolled in Part A and Part B. — Q: A: Anyone with Medicare Parts A and B can buy a policy, although guaranteed rights apply only to those 65 or older who purchase policies during a specific time period. — Today' s Topics
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