Medicare Advantage Programs
Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage.
Medicare Advantage Plans include:
Medicare Health Maintenance Organization (HMOs)
Preferred Provider Organizations (PPO)
Private Fee-for-Service Plans
Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy
Medicare Supplement or Medigap Programs
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.
You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan, A through L, has a different set of basic and extra benefits.
Beginning June 1st, 2010 Medicare Supplemental Insurance (Medigap) will include two new choices for consumers - Medicare Supplement Plan M and Medicare Supplement Plan N.
At that time Medigap plans E, H, I, and J will be eliminated as the "Preventive Care Benefit" and the "At-home-Recovery" benefit are removed and these plans become identical to other lettered Medicare Supplement plans. Medicare has deemed these two benefits unnecessary in the current Medicare structure. In addition to these changes, a hospice care benefit Co-insurance coverage will be added to all new Medicare Supplement Plans.
It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.
NOTE: The information shown in this site is just a very brief description, and while these concepts are valuable to you, it is CRITICAL that you get all the details that are applicable to your own personal situation. How do the details work? Are they suitable for you? What is the difference between saving and investing?
Please call 972-979-1701 for your free personal consultation as to how any of these programs might, or might not, work for you.
LynStar Benefits, LLC does not provide tax or legal advice. It is important to coordinate with your tax or legal advisor regarding your specific situation.
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