Original Medicare Plan
The Original Medicare plan is run by the federal government. It is a traditional pay-per-visit health plan that lets you go to any doctor, hospital, or other health care provider who accepts Medicare. You pay the deductible. Medicare pays its share of the Medicare-approved amount, and you pay your share. The Original Medicare Plan has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
- Part A (Medicare)
Hospital insurance that covers hospice care, home health care, skilled nursing facilities, and inpatient hospital stays.
- Part B (Medicare)
Medical insurance that helps pay for doctors’ services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A.
You pay the $78.20 Part B premium, the Part A and Part B deductibles, and the coinsurance.
There are many types of private health insurance/coverage that you can buy to supplement, or fill the gaps, in your Medicare coverage. This supplemental insurance will pay for some or all of your health care costs that are not covered by Medicare. These types of private health insurance/coverage include:
- Employee or Retiree Coverage
(from your employer or union)
- Medigap Insurance
(from a private company or group).
People often refer to all of these types of private health insurance/coverage as “supplemental insurance.” However, “Medicare Supplemental” or “Medigap” insurance is a specific type of private insurance that is subject to Federal and State laws.
Medicare supplemental insurance policies that are sold by private insurance companies to Medicare beneficiaries to fill the “gaps” in Original Medicare Plan coverage. There are ten standardized policies, labeled Plan A through Plan J. Your State decides which of the 10 policies can be sold in your State. Medigap policies only work with the Original Medicare Plan.
A type of Medigap policy that must meet all of the requirements that apply to a standard Medigap policy. You may be required to use doctors and hospitals within its network in order to be eligible for full benefits.
Managed Care Plans
A Managed Care plan involves a group of doctors, hospitals, and other health care providers who have agreed to provide care to Medicare beneficiaries in exchange for a fixed amount of money from Medicare every month. Managed Care plans include Health Maintenance Organizations (HMOs), HMOs with a Point of Service (POS) option, Provider Sponsored Organizations (PSOs), Preferred Provider Organizations (PPOs), and Cost Plans.
You pay a $78.20 Part B premium. Some plans charge an extra monthly premium. You may also pay the plan a copayment per visit or service. You will pay more if you don’t follow plan rules. No Supplemental Insurance policy is necessary if you join a Managed Care plan.
- HMO – You must go to plan doctors and hospitals.
- HMOs with POS Option – You may use doctors and hospitals outside of the Managed Care plan at an additional cost.
- PSO – You must go to plan doctors and hospitals.
- PPO – You may use doctors and hospitals outside of the
- Managed Care plan at an additional cost.
- Cost Plans – You may use doctors and hospitals outside of the Managed Care plan. You will pay the coinsurance, deductible, and extra charges that you would normally pay under the Original Medicare plan.
There are two main advantages associated with managed care plans. The first is low premiums. The second advantage is many managed care plans offer additional benefits not covered under the Original Medicare plan.
Managed care plans are not very flexible and the covered person has very little say in treatment options. Managed care plans are not guaranteed renewable and many managed care plans have pulled out of areas forcing people to find new coverage.
Although managed care plans are required to provide benefits similar to Medicare not all plans are the same. Shop around on your own compare rates and benefits from several companies to make sure you get a plan that’s right for you. It is also very important to choose a company with a excellent rating. For more information and rates on managed care coverage visit our specialist site below.
For more information or to start your policy today, contact our sales representatives at 1-866-351-MSIG(6744)