Medicare Health Plans

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.

If you join a Medicare Advantage Plan, you will still have Medicare but you will get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare.

You will generally get your services from a plan’s network of providers. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Medicare Advantage Plans cover all Medicare Part A and Part B services In all types of Medicare Advantage Plans, you are always covered for emergency and urgent care.

Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, Original Medicare covers hospice care, some new Medicare benefits, and some costs for clinical research studies, even if you are in a Medicare Advantage Plan.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs.
Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might have to pay a monthly premium for the Medicare Advantage Plan.

What are the different types of Medicare Advantage Plans?

Health Maintenance Organization (HMO) plans.
Preferred Provider Organization (PPO) plans
Private Fee-for-Service (PFFS) plans
Special Needs Plans (SNPs)

HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance. Important!

Medical Savings Account (MSA) plans—These plans combine a high-deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA plans do not offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.

What are Medicare Supplement Insurance (Medigap) Policies?
Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Medicare Supplement Insurance policies are also called Medigap policies. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Medigap policies are standardized. Every Medigap policy must follow federal and state laws designed to protect you and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

What else should I know about Medicare Supplement Insurance (Medigap)?
Important facts
You must have Part A and Part B.

You pay the private insurance company a monthly premium for your Medigap policy in addition to your monthly Part B premium that you pay to Medicare. Contact the company to find out how to pay your premium.

A Medigap policy only covers one person. Spouses must buy separate policies.

You can’t have prescription drug coverage in both your Medigap policy and a Medicare drug plan. See page 95.

It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap premium costs.
When to buy?
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.

If you delay enrolling in Part B because you have group health coverage based on your (or your spouse’s) current employment, your Medigap Open Enrollment Period won’t start until you sign up for Part B.

Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65.

How does Medicare prescription drug coverage (Part D) work?
Medicare offers prescription drug coverage to everyone with Medicare. Even if you do not take many prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, and you do not have other creditable prescription drug coverage or get Extra Help, you will likely pay a late enrollment penalty if you join a plan later.

Generally, you will pay this penalty for as long as you have Medicare prescription drug coverage. To get Medicare prescription drug coverage, you must join a plan approved by Medicare to offer Medicare drug coverage. Each plan can vary in cost and specific drugs covered.

There are two ways to get Medicare prescription drug coverage:
1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and/or Part B to join a Medicare Prescription Drug Plan.

2. Medicare Advantage Plans (like HMOs or PPOs) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

What is a Medicare MSA Plan?
Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare MSA Plan. These plans are similar to Health Savings Account Plans available outside of Medicare. You can choose your health care services and providers.

Medicare MSA Plans have 2 parts

1. Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.
   High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C) . The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
2. Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account. You can use money from this savings account to pay your health care costs before you meet the deductible.

How do MSA Plans work?

10 steps to use a Medicare MSA Plan

1. Choose and join a high-deductible Medicare MSA Plan.
2. You set up an MSA with a bank the plan selects.
3. Medicare gives the plan an amount of money each year for your health care.
4. The plan deposits some money into your account.
5. You can use the money in your account to pay your health care costs, including health care costs that are not covered by Medicare. When you use account money for Medicare-covered Part A and Part B services, it counts towards your plan’s deductible .
6. If you use all of the money in your account and you have additional health care costs, you will have to pay for your Medicare-covered services out-of-pocket until you reach your plan’s deductible.
7. During the time you are paying out-of-pocket for services before the deductible is met, doctors and other providers cannot charge you more than the Medicare-approved amount.
8. After you reach your deductible, your plan will cover your Medicare-covered services. Read information from the plan for details about out-of-pocket costs .
9. Money left in your account at the end of the year stays in the account and may be used for health care costs in future years.
10. If you use funds from your account, you must include a special IRS Tax Form 8853 with information on how you used your account money when you file taxes.

What’s covered?

• Medicare MSA plans cover the Medicare services that all Medicare Advantage Plans must cover. In addition, some Medicare MSA plans may cover extra benefits for an extra cost, like:
• Dental
• Vision
• Long-term care not covered by Medicare
  We will contact plans in your area for more information on what extra benefits they cover if any

Medicare MSA Plans do not cover Medicare Part D prescription drugs
If you join a Medicare MSA Plan and need drug coverage, you will have to join a Medicare Prescription Drug Plan.