Guiding People Towards Their Health Plan
Medigap or Medicare Supplements
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in an original Medicare plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Medicare Advantage Plans
Medicare Health Plans (like HMOs and PPOs) often cover prescription drugs. Medicare Health Plans include:
- Medicare Advantage Plans
- Other Medicare Health Plans
Medicare Advantage Plans (like HMOs and PPOs) that include prescription drug coverage as part of the plan are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program. If you join a Medicare Advantage Plan you are still in Medicare.
- You generally get all your Medicare-covered health care through that plan.
- You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs.
- You usually will have to pay some other costs (such as co-payments or co-insurance) for the services you get. Out-of-pocket costs in these plans are generally lower than in original Medicare plans, but vary by the services you use.
- You may have to see doctors that belong to the plan or go to certain hospitals to get covered services.
Medicare Prescription Drug Plan
If you do not opt for prescription drug coverage when you are first eligible, you may have to pay a late enrollment penalty of 1% based upon Medicare’s average cost of a prescription drug plan, for every month that you were not enrolled. If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs by contacting your local Social Security Office to see if you qualify for a Low Income Subsidy.
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-For-Service (PFFS) Plans
- Medicare Medical Savings Account (MSA) Plans
- Medicare Special Needs Plans (SNP)
- Original Medicare
- Some Medicare Cost Plans
- Some Medicare Private Fee-for-Service Plans and
- Medicare Medical Savings Account Plans
- Generally, you pay less for your prescriptions.
- You will get a plan member card after you enroll. You use this card when you go to the pharmacy to get your prescriptions filled.
- You will pay the copayment, coinsurance, and/or deductible, if any