Toni:           

I have been studying the difference between Original Medicare’s Plan F and Medicare’s Part C or even D. What is with all the different plans, parts or letters?           

Can you explain these simple terms because I can understand what is going on?

 Thanks,

James, an overwhelmed American turning 65.

 

James:

I will make this as simple as I can…. The different Parts such as A, B, C and D are parts of Medicare and the different Plans such as Plan F and G are Medicare Supplements (aka Medigap). Policies which help those on Medicare pick up out of pocket costs.

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 Supplement helps pick up out of pocket costs
  • Medicare Part B: (Medical Insurance) covers doctor services, outpatient care and surgery, durable medical equipment and preventative services. Medicare Supplement helps pick up out of pocket costs.
  • Medicare Part C: aka Medicare Advantage Plan and is not a Medicare Supplement
  • Medicare Part D: is a Medicare prescription drug coverage which is administered by private insurance companies.

There are 2 chapters in the “new” Medicare Survival Guide® Advanced edition, which explains in detail with various articles and graphs the difference in Medicare Supplements and Medicare Advantage Plans.

In chapter 3 of the Advanced Guide, it explains Medicare Supplements/Medigap policies and gives examples of how and when to enroll correctly.  In chapter 4 of the new guide, Medicare Part C, aka Medicare Advantage plans are explained in scenarios involving various type of plans…HMO, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans).

Below is how Medicare Supplements and Medicare Advantage Plans are different:

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 pay its share.
  • Freedom to choose whichever hospital, doctor or medical provider you want.
  • The premium may increase every year.
  • You can enroll and will pay separately for a “Stand alone” Medicare (Part D) Prescription drug plan if you don’t enroll at the right time, you may be subject to a Part D Late Enrollment Penalty.

 2) Part C – Medicare Advantage Plans: HMO, PPO, PFFS, SNP

To qualify:

  • You must be enrolled in both Medicare Parts A & Part B
  • Live in the area 6 months a year
  • Not have end stage renal disease (kidney dialysis)
  • Medicare pays the Medicare Advantage insurance company a certain amount every month for your care while you are on the plan. Your Part B must always be in effect.
  • You use your Medicare Advantage insurance card, not your Medicare red, white and blue card.
  • Plan must provide 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 premium with various co pays, deductibles and a 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)

Medicare Open Enrollment is the time for making a change to your Medicare option and is explained in chapter 6 of the “New” Medicare Survival Guide® Advanced available at www.tonisays.com or call the new Toni Says® Medicare call center at 1/844-250-8664 to have your Medicare Open Enrollment questions answered. Also, if you are still confused and have more questions about Medicare please sign up for our free Medicare webinars at http://tonisays.com/index.php/webinar/

Share This