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What type of Medicare coverage should you choose? What type of Medicare plan is best for you?

Before we go into the types of Medicare plans, let's start with the basics of coverage. You've probably heard of Medicare Part A, Medicare Part B, and/or Medicare Part D. Do you know what these mean? Below is a definition for each:

  • Medicare Part A is hospital insurance that helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care.
  • Medicare Part B is medical insurance that helps pay for doctors' services and many other medical services and supplies that are not covered by hospital insurance.
  • Medicare Part C is “Medicare Advantage” plans that are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through one of these health insurance organizations under Part C.
  • Medicare Part D is prescription drug coverage that helps pay for medications doctors prescribe for treatment.

 

AIDS Healthcare Foundation operates Positive Healthcare Partners, a Medicare Advantage Prescription Drug (Part D) Special Needs Plan (SNP) that is designed specifically around the needs of people living with HIV/AIDS. Positive Healthcare Partners is available in Los Angeles County, California, and Broward and Miami-Dade Counties, Florida. Click here or California residents call (800) 263-0067, Florida residents call (888) 456-4715 for more information.

As far as Medicare health plans go, we will start with Original Medicare. Original Medicare is the basic “fee-for-service” (FFS) plan that lets you choose any doctor you want who accepts Medicare. With Medicare FFS, you generally have to pay co-insurance, or part of the cost, to get healthcare services. For example, if you see a doctor for a routine visit, Medicare covers 80% of the cost of the Medicare-approved amount the doctor can charge. You pay 20%. So, if you see your doctor frequently, you will have to cover a coinsurance charge whenever you see him or her. If you want to see more information about Original Medicare including plan costs, you should review the 2009 Medicare & You publication from Medicare.

Original Medicare is good for people who want the flexibility of seeing any doctor they wish who accepts Medicare. Original Medicare may not be the best choice for somebody who sees the doctor or uses hospital services a lot, or takes many medications. The cost to enroll in Original Medicare is the Part B premium, which is $96.40 for 2009. This amount usually is increased every year. This premium is deducted from your Social Security check. If you don't get a Social Security check, Medicare will either send you a bill for your Part B premium every three months or you can use Medicare Easy Pay as an electronic payment option. For people who qualify for Medicaid assistance, Medicaid will pay part or the entire monthly Part B premium.

It is important to note that Original Medicare does not include prescription drug coverage. To have the cost of your drugs covered, you need to add on a prescription drug plan or enroll in a Medicare Advantage Prescription Drug Plan that covers Medicare Part C and D (remember Medicare Part C covers Parts A and B).

Medicare Advantage Plans (remember, these cover Parts A and B) are operated by health plan companies. Medicare contracts with outside companies to offer these various types of plans to you. Here are the types:

 

  • Health Maintenance Organizations (HMOs). HMOs provide healthcare through a network of doctors, hospitals and other providers. Many HMOs have no co-pays to use healthcare services, however, you generally have to use the HMOs network of providers or you'll have to cover the cost of any out-of-network services yourself. If you choose an HMO, it's a good idea to look at its network of doctors to find out if your preferred doctor is part of it. If your doctor isn't, you can ask the HMO if it can add your doctor.

  • Preferred-Provider Organizations (PPOs). PPOs offer basically the benefits of an HMO with the added flexibility to choose doctors and hospitals in and outside of a network. The costs to be a member of a PPO are generally higher than what you'd pay to be part of an HMO.

  • Private Fee-for-Service Plans (PFFS). PFFS require no special networks or providers. You can visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you, and accepts the plan's terms and conditions.

  • Special Needs Plans (SNPs). SNPs are plans that are designed around the needs of people who are either eligible for state Medicaid health insurance or have a chronic disease or both.

Any additional premium to join a Medicare Advantage plan, regardless of the type, is in addition to your Part B premium that you must pay regardless of which plan you might choose. Some Medicare Advantage plans have no monthly premiums. The plans that offer more benefits, like prescription drug coverage, will charge a monthly premium on top of the Part B premium.

Original Medicare does not include prescription drug coverage. Remember, prescription drug coverage is Medicare Part D. This is an important benefit especially if you take many medications and have a high medication costs. Everyone with Medicare can get prescription drug coverage. Like Medicare Advantage plans, Part D is only available from private companies. There are two ways to get prescription drug coverage:

Everyone with Medicare can get prescription drug coverage. Like Medicare Advantage plans, Part D is only available from private companies such as Aetna Medicare. Each plan can vary in cost and drugs covered.

You have two choices for drug coverage under Part D:

  • Prescription drug coverage as part of a Medicare Advantage plan (these plans are often called "MAPD" plans). This will give you all of your coverage in one plan, for one monthly plan premium that often costs less than you would pay for each separately.
  • A stand-alone Medicare prescription drug plan in addition to your existing Original Medicare (Part A and B) coverage. These plans are sometimes referred to as "PDP" plans and only offer prescription drug coverage.

 

Prescription drug plans vary in costs and drugs covered, so you should pay close attention to premium costs, drugs covered (look at the plans' formularies), and co-pays.

If you have questions about Medicare, go to www.medicare.gov. This website has a great deal of information that can help you choose the plan that's best for you. You can also call Medicare 24 hours a day, seven days a week at 1-800-MEDICARE (800-633-4227).