Medicare 123

Understanding Medicare 

Part A          Hospitalization                       No Cost for most Americans

Part B          Outpatient                             $110.50 or $115.50 Month

Part D          Prescription Medications         Price varies, based on plan chosen 

Part C           From Private Insurance & Includes Parts A, B & D             

Medicare is a fee for service program where the recipient pays 20% and Medicare pays 80/%. 

Part C is run by private insurance companies and is referred to as an MAPD

(Medicare Advantage Prescription Drug plan).

3 Types of Plans

HMO                       Referrals required seeing physicians other then your primary. 

                              These plans have no premium. 

PPO                        No referrals required, the physicians are in the provider book and you can see anyone in the book. Monthly premiums range from $0-$116 per month depending upon the carrier. 

PFFS                       Private Fee For Service plans allow the recipient to go to any doctor, any hospital anywhere in the US as long as they service provider accepts Medicare and the plans payments and terms and conditions. PFFS plans pay what Medicare pays but the service provider cannot bill the excess that Medicare allows if the patient signs the assignment forms.

Part D                     Stand alone prescription plans are provided so recipients can get price breaks on the medications. All plans follow the Medicare guidelines including the donut hole.

Understanding Medicare Supplements

Medicare Supplements are plans that work with Original Medicare and pay part or all of what Original Medicare doesn’t cover.

Med Supplement plans are designated by letter so the plans range from plan A through plan N. Medicare will be adding some new plans later in 2010 and also eliminating some plans as well.

Medicare controls the plan descriptions so all like plans are the same regardless of insurance carrier. The monthly premiums can be different depending upon carrier.

Plan F appears to be the most popular plan.

When you visit a provider all you need is your Original Medicare card and your Medicare Supplement card. All services are covered without any payments from you.