Deciphering the A, B, C and D of Medicare Advantage Plans

For some seniors, the start of the Annual Election Period (AEP) – which began October 15 and runs through December 7 – for Medicare Advantage Plans has become an annual ritual fraught with perplexity and some anxiety. Even the savviest seniors can have trouble decoding the maze of confusing alphabets and the dozens of Medicare Advantage Plan offerings.

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But choosing the right Medicare Advantage Plan for you doesn’t require a Mensa IQ, just a simple road map. However, before starting your journey to select a plan, do your homework comparing and contrasting several plans to find the right one for you. In the process, ask plan representatives three simple questions:

  • What’s my share of the costs for services and supplies?
  • Does the plan have a network of providers for some or all categories of services? (You can still see providers who aren’t part of the plan’s network if they accept the plan’s payment terms, but you may pay more.)
  • Does the plan offer benefits Original Medicare doesn’t cover, like vision, hearing, dental, or prescription drug coverage? (Note: you may have to pay more for these extra benefits.) If the plan doesn’t offer drug coverage, you can get coverage by joining a Medicare Prescription Drug Plan (Part D).

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The answers to those questions can be found on the websites of most plans. But you also have the option of directly contacting plans to get answers or clarification. Many plans, like the Memorial Hermann Advantage HMO and PPO plans are offering free seminars throughout the Annual Enrollment Period to help answers your questions.

Breaking Down Medicare, Part by Part

Medicare is a federal health insurance program for people ages 65 or older. Others younger than 65 may also be eligible if they have certain disabilities or diseases, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), otherwise known as Lou Gehrig’s disease. Learn more about ESRD eligibility. Here’s what you need to know:

Medicare Part A (Original Medicare or Hospital Insurance)

Part A primarily covers inpatient costs. These costs can include hospital stays for a set number of days, brief stays in a skilled nursing facility (for rehabilitation) and hospice benefits (including hospice care, prescription medications and grief counseling). Additionally, if certain conditions are met, Part A may also include some home healthcare benefits.

Medicare Part B (Medical Insurance)

Part B primarily covers outpatient costs, including doctor visits. Part B covers certain services, such as X-rays, lab tests, chemotherapy and vaccinations, among other treatments administered in a doctor’s office or on an outpatient basis. Outpatient care, home health, ambulance services and preventive services may also be covered. Part B can also help with the cost of medical supplies, including durable medical equipment such as canes and scooters for the mobility-impaired, prosthetic devices, oxygen, and eyeglasses. Generally, you pay 20 percent of the Medicare-approved amount after you pay your Medicare Part B deductible for the year. Medicare pays the other 80 percent.

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Medicare Part C (Medicare Advantage Plans)

Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by private health insurance companies, contracted with Medicare, that sell products to provide you with all of your Part A and Part B benefits. While you must continue to pay your Medicare Part B premium, Part C coverage can help pay for services that Original Medicare does not cover. In many cases, Medicare Advantage plans offer enhanced benefits that Original Medicare does not cover, like vision, dental and prescription drug coverage. Therefore, benefits and costs may vary from plan to plan. Medicare Advantage plans can be offered by Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNPs) and Medical Savings Account Plans (MSAs).

Medicare Part D (Prescription Drug Coverage)

Part D is run by Medicare-approved private insurance companies and helps people eligible for Medicare to pay for their prescription drugs. You can get Part D through a stand-alone Prescription Drug Plan (PDP) or you can get it through a Medicare Advantage Prescription Drug Plan. Because these are privatized benefits, costs can vary.

Remember, there are dozens of plans to choose from — all with different costs and levels of coverage.

Protect Yourself from Medicare Fraud

All consumers need to watch out for  Medicare fraud. There are always unscrupulous people lurking around to commit Medicare fraud by getting an unwitting Medicare member’s number. So, never give your Medicare number to get a free offer or gift. If you believe you or someone you know is a victim of Medicare fraud, you can:

  • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • Report it online to the Office of the Inspector General.
  • Call the Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.

To learn more about Memorial Hermann Medicare Advantage HMO and PPO plans, click here.

Comments

  1. I wasn’t aware that that people younger than the age of 65 could possibly be eligible for medicare if they have certain disabilities or diseases. That’s good to know! I’ve heard that those with insurance end up paying less money over the course of their adult lives. Is that true? I’ll have to keep this in mind this next year as we choose a plan for my mother!

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