Medicare Advantage
Medicare is a U.S. federal health insurance program for Americans who become eligible for Social Security benefits, and for certain disabled persons including those with end-stage renal disease.
Medicare “Part A” covers hospital services and is does not have a monthly cost because those who are eligible have paid into the Medicare system while they worked.
Medicare “Part B” (also known as “supplementary medical insurance”) covers physician services, supplies ordered by a physician, and selected other services. Part B premiums are subsidized by Medicare, but enrollees pay part of the premiums.
Medicare does not cover prescription drugs, or for nursing home care. Medicare only pays for inpatient skilled nuring care under certain circumstances.
Medicare is a (FFS) fee for service insurance program that allows seniors wide flexibility in their choice of providers. Since 2006 seniors now have the option of enrolling in a Medicare-contracted health plans (PPO’s and HMO’s) which have benefits equal to or greater than original Medicare.
Coordination of benefits applies with Medicare if you or your spouse have health insurance through your employer. If you are under 69 and still working and your employer has 20 or more employees, then your employer must offer you the same insurance that other workers get. You can select whether Medicare or your company’s insurance will be your primary insurance. Generally it is better to select your employer’s insurance as primary so that you do not have to pay Medicare Part B premiums unless you have a high deductible health plan at your group that costs you more out of pocket.
“Medigap” insurance (also called “Medicare Supplemental” or “Medisup” Insurance) is private insurance that pays for some or all of the out-of-pockets costs that Medicare does not cover. All of the plans offered by Medicare are standardized which means that the plans have the same benefits no matter the company. If a provider accepts Medicare generally speaking they are going to accept what ever suppliment that follows.
Two booklets can help you select one of the standardized Medigap policies. The first is — “Guide to Health Insurance for People with Medicare” available at the Center for Medicare and Medicaid Services (CMMS), Publications, N1-26-27, 7500 Security Blvd., Baltimore, MD 21244-1850. CMMS was once the Health Care Financing Administration. The second is — “The Consumer’s Guide to Medicare Supplement Insurance” provided by the Health Insurance Association of America, 555 13th St., N.W., Suite 600 East, Washington, D.C. 20004.
You can also visit the U.S. government’s consumer website for Medicare.