Toni:
I attended your “Confused about Medicare” workshop in September at Sugar Creek Baptist Church and I still I don’t understand the difference between Original Medicare’s Plan F and Medicare’s Part C or even D. What is with all the different plans and parts?
I am turning 65 on January, 2014 and am absolutely baffled with all of the advertising coming to me… Can you explain these simple terms, so I can understand what is going on?
Thanks, Jerry, an overwhelmed Texan turning 65.
Hi there, Jerry:
This is not as confusing as you might think. I will make this as simple as I can….The different Parts such as A, B, C and D involve Medicare and the different Plans such as Plan F have to do with Medicare Supplements also known as Medigap policies. I will explain them in detail below:
Original Medicare has 4 different Parts: A, B, C, & D
- Medicare Part A: (Hospital Insurance) covers inpatient hospital stays,
skilled nursing stay, hospice and home health
- Medicare Part B: (Medical Insurance) covers doctor services, outpatient care and surgery, durable medical equipment and preventative services.
- Medicare Part C: is also known as Medicare Advantage Plans
- Medicare Part D: Medicare prescription drug coverage which is administered by private insurance companies.
Let’s discuss the difference in the two types of Medicare options.
There are 2 chapters in my book, Medicare Survival Guide that explains the difference in Part C and Medicare supplements. In chapter 6, I explain what are Part C or Medicare Advantage plans and the different type of plans…HMP, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans). In chapter 8 of the Medicare Survival Guide, I discuss Medicare Supplements, also known as Medigap policies.
Below are some of the differences between a Medicare Supplement and a Medicare Advantage Plan:
1) Medicare Supplement: Plans A, B, C, D, F, G, K, L, M, N
- A Medicare Supplement works directly with “Original Medicare”. Medicare will pay its share of the Medicare-approved amount for Medicare covered healthcare costs. Then your Medicare supplement will pays its share.
- Freedom to chose which doctor, hospital, etc
- The premium may increase every year.
- You can enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan. Don’t enroll at the right time then you may be subject to a Part D Late Enrollment Penalty
2) Part C – Medicare Advantage Plans: HMO, PPO, PFFS, SNP
- To qualify: a) You must be enrolled in both Medicare Parts A & Part B b) Live in the service area 6 months out of a year c) Not have end stage renal disease (kidney dialysis)
- 2. Medicare pays the Medicare Advantage insurance company a certain amount every month for your care as long as you are on the plan. Your Part B must always be in effect.
- You must only use your Medicare Advantage insurance card, not your Medicare red, white and blue card.
- Plan must provide all of your Part A and Part B benefits and some Medicare Advantage Plans have Part D prescription drug plans included.
- May have a zero to low dollar premiums with various co pays, deductibles and has maximum out of pocket to meet
- Many plans offer extra benefits such as gym memberships, dental benefits, transportation and other additional benefits.
- Many healthcare facilities, such as MD Anderson accept very few Medicare Advantage plans. Call your specific provider or facility and make sure they accept which Medicare Advantage plan you want to enroll in… (Very Important)
Toni King’s “Confused about Medicare” workshops are finished for 2013. A new series will begin in January 2014. For those who need guidance or have questions about Medicare visit Toni’s website at www.tonisays.com. Also available is a DVD of the “Confused about Medicare” workshop for those who could attend a workshop.
Toni is an advocate/consultant for those “Confused about Medicare”. Email questions to toni@tonisays.com or call 832/519-TONI (8664).
