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Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). There are a variety of plans and choosing the one that fits your situation is an important decision.
Often times, people will talk about Medicare Plans using different terms and in different ways. Medicare Supplement Plans include what is commonly referred to as Medigap Insurance fills in the gaps of original Medicare.
The terms and policy types can get confusing. We've put together some plain language definitions to help you better understand Medicare options and benefits below from the government's own glossary of terms from the official Medicare website.
Just give us a call to learn more about Medicare Insurance.
What is a Medicare Health Plan?
Generally, a Medicare Health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, and Demonstration/Pilot Programs.
Programs of All-inclusive Care for the Elderly (PACE) organizations are special types of Medicare health plans. We can explain PACE plans and how they work with your original coverage, but PACE plans are offered by public or private entities by providing Part D and other benefits in addition to Part A and Part B benefits.
What is Medicare Part A (Hospital Insurance)?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part A Plans include deductibles and co-pays.
What is Medicare Part B (Medical Insurance)?
Medicare Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Medicare Part B Plans include deductibles.
What is Medicare Advantage Plan (Part C)?
Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
Most Medicare Advantage Plans offer prescription drug coverage.
What is Medicare Prescription Drug Coverage (Part D)?
Optional benefits for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by Medicare.
What is Medicare Prescription Drug Plan (Part D)?
Medicare Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
These plans are offered by insurance companies and other private companies approved by Medicare.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare Supplement Insurance sold by private insurance companies to fill "gaps" in Original Medicare coverage.
Medigap Basic Benefits
Benefits that all Medigap policies must cover, including Part A and Part B coinsurance amounts, blood, and additional hospital benefits not covered by Original Medicare.
Medigap Open Enrollment Period
A one-time-only, 6-month period when federal law allows you to buy any Medigap policy you want that's sold in your state. It starts in the first month that you're covered under Part B and you're age 65 or older. During this period, you can't be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional open enrollment rights under state law.
Medicare Cost Plan
A Medicare Cost Plan is a type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for under Original Medicare (your Cost Plan pays for emergency services or urgently needed services).
Medicare Health Maintenance Organization (HMO) Plan
A type of Medicare Advantage Plan (Part C) available in some areas of the country. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list except in an emergency. Most HMOs also require you to get a referral from your primary care physician.
Medicare Medical Savings Account (MSA) Plan
MSA Plans combine a high deductible Medicare Advantage Plan and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount so you generally will have to pay out-of-pocket before your coverage begins.
Medicare Preferred Provider Organization (PPO) Plan
A type of Medicare Advantage Plan (Part C) available in some areas of the country in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Medicare Private Fee-For-Service (PFFS) Plan
A type of Medicare Advantage Plan (Part C) in which you can generally go to any doctor or hospital you could go to if you had Original Medicare, if the doctor or hospital agrees to treat you. The plan determines how much it will pay doctors and hospitals, and how much you must pay when you get care. A Private Fee-For-Service Plan is very different than Original Medicare, and you must follow the plan rules carefully when you go for health care services. When you're in a Private Fee-For-Service Plan, you may pay more or less for Medicare-covered benefits than in Original Medicare.
A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.
Medicare Special Needs Plan (SNP)
A special type of Medicare Advantage Plan (Part C) that provides more focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, who live in a nursing home, or have certain chronic medical conditions.
Medicare Extra Help
Extra Help is available. If you have limited income and resources, you may be able to get Extra Help paying prescription drugs coverage costs. CViS can help you determine if you might qualify and eve help you apply online.
Click here to go to the SSA site, guidelines and online application.
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