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Medicare News
Time to Prepare for Medicare’s Open Enrollment
Season – Original or Advantage?
Medicare Rights Center outlines things senior
citizens should consider
 Sept. 17, 2007 - It’s fall again, the season when
health insurance companies begin marketing Medicare private health
plans. Each year, from November 15 to March 31, everyone with Medicare
has the option to change their Medicare coverage, either to Original
Medicare or to one of the private health plans known as Medicare
Advantage plans.
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The vast majority of people who have Medicare stick
with Original Medicare—the traditional fee-for-service program run by
the federal government—which offers access to virtually any doctor,
specialist and hospital in the country.
Many insurance companies advertise Medicare private
health plans that have low premiums or offer special benefits. These
plans must cover at least the same inpatient (Part A) and outpatient
(Part B) services covered by Original Medicare.
Private health plans may also offer additional
benefits, like dental or vision care, that Original Medicare does not
cover. Many offer Medicare prescription drug coverage (Part D) as part
of their benefits packages. Keep in mind, however, that there is much
more to consider when choosing how to get your Medicare health coverage.
Regardless of what health plan you choose, most
people will be locked into that plan from March 31st until the end of
the year.
If you sign up for a Medicare private health plan,
you will get your Medicare benefits through the plan. You must follow
the private health plan’s rules and will most likely incur high
out-of-pocket costs if you do not.
Some of the most commonly offered types of Medicare
private health plans are health maintenance organizations (HMO),
preferred provider organizations (PPO), and private fee-for-service (PFFS)
plans.
Before you sign up for a Medicare private health
plan, make sure you can use the doctors, specialists and hospitals that
you prefer. Private health plans restrict you to certain providers,
usually from their provider network. Often, you need a referral from
your primary care doctor before you can see a specialist. Your doctor
may also have to follow certain rules, like seeking the private health
plan’s approval before prescribing a treatment or admitting you to the
hospital. These limitations might make it difficult for you to get
urgent care, or care that you need when you travel outside your private
health plan’s network.
Private health plans can be costly, so make sure
you can afford a plan before you join it. Make sure you know all your
private health plan’s costs, since some charge higher copays for certain
types of care, like cancer care.
Also, understand the rules in advance. If you do
not follow the private health plan’s rules you may have to pay up to the
full cost of the service. Keep in mind that private health plans can
change their rules, provider networks and costs every year.
If you choose Original Medicare, it is best to also
have supplemental coverage which helps cover health care costs that
Medicare does not cover. If you do not have a retiree health plan to
supplement Original Medicare, you can buy a supplemental plan known as a
Medigap plan.
You can also buy a stand-alone Medicare private
drug plan (PDP) that works with Original Medicare to give you Medicare
prescription drug coverage (Part D).
Low-income people with Medicare may be eligible for
Medicare Savings Programs that help with the out-of-pocket costs of
Original Medicare.
To read more about how to choose a Medicare health
plan, Medicare prescription drug coverage, and supplemental coverage,
including Medigap plans and Medicare Savings Programs, log on to the
Medicare Rights Center website at
http://www.medicarerights.org/help. html.
Medicare Interactive is a resource provided by the
Medicare Rights Center, which claims to be the largest independent
source of health care information and assistance in the United States
for people with Medicare.
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