Medicare: America's Health Insurance Plan for Seniors
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published August 20, 2007
Shaileja Mammen
Those who are eligible can get Medicare coverage under two types of plans: Original Medicare and Medicare's Advantage Plans.
Original Medicare has two parts:
hospital insurance (Medicare Part A), which covers hospital services
medical insurance (Medicare Part B), which is optional and covers doctors' services, outpatient care, and other medical services
Under Original Medicare, the benefits available include hospital insurance. You can also opt for supplemental insurance that fills in the gaps in Part A and Part B coverage as well as prescription drug coverage.
The cost of insurance to the beneficiary depends on the plan opted for and the services used.
Medicare Advantage Plans (Medicare Part C)
Private insurance companies approved by Medicare provide this type of coverage. The private company contracts with Medicare to provide all of the benefits under Medicare Part A and Part B. HMOs, PPOs, private fee-for-service plans, and Medicare Medical Savings Account plans qualify as Medicare Advantage Plans. Most Part C plans cover prescription drugs, and one can opt for prescription drug coverage if his or her plan does not automatically cover it.
Medicare Prescription Drug Coverage (Medicare Part D)
Medicare Part D is a stand-alone plan offered by insurance companies and other private companies. Those who are covered under Original Medicare, Medicare cost plans, Medicare medical savings account plans, or private Medicare fee-for-service plans that do not provide prescription drug coverage can opt to receive benefits under Plan D. Medicare Advantage Plans (Plan C) may also offer Part D prescription drug coverage.
How Can You Get the Services Covered by Medicare?
To benefit from the services covered, you must decide which type of coverage to opt for. You must choose a plan when you become eligible for Medicare. This choice can be reviewed every year. When making your choice, you should consider the cost of the plan; its benefits; which hospitals, doctors, and pharmacies are in its network; the convenience of access; and the quality of care. You must also find out whether the plan will provide coverage if you travel to another state. Your drug needs and their costs must also be assessed before you choose a plan.
If you have or are eligible for certain other types of health insurance coverage or prescription drug coverage, do not make any changes to your existing coverage before discussing your situation with your benefits administrator, insurer, or plan provider. These other types of coverage include employer or union coverage or any other type of group insurance coverage.
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