Medicare is a United States federal program that supplies eligible individuals with health care benefits to help reduce the cost of their medical care. To qualify, an applicant must be at least 65 years old; if the applicant is younger, he must have an accepted disability or medical condition such as advanced renal disease that requires a transplant or dialysis. People who are accepted into the program then have access to four types of Medicare plans, which can be combined for maximum benefits.
Original Medicare Plan
The Original Medicare Plan is a two-part insurance program very similar in structure to a coinsurance plan. Participants can receive medical services from any available medical professional or facility that accepts Medicare. In return for this freedom, the patient must pay a deductible as well as any additional costs after Medicare covers a pre-approved amount.
Medicare Health Plans
Medicare Health Plans, or Medicare Advantage Plans, include various programs offered by independent companies yet approved by Medicare. They include some Health Maintenance Organizations (HMOs), Medicare Medical Savings Account Plans (MSAs), Preferred Provider Organizations (PPOs), and Private Fee-for-Service Plans (PFFSs), in addition to other programs.
The most important attributes of the Medicare Advantage Plans are that they often include a wider range of benefits, such as coverage for prescription drugs. They can range in price, premium and the amount of medical coverage. They sometimes require the Medicare participant to be referred to them by a specialist; and they frequently have unique network requirements, such as restrictions on available doctors and health care facilities for receiving services.
Medicare Prescription Drug Plans
Medicare Prescription Drug Plans provide coverage for the cost of prescriptions that results in lower prices at pharmacies after enrollment. The plans are supplied by both insurance and private companies pre-approved by Medicare, and they typically require deductibles, co-payments and coinsurance. Medicare participants can have the prescription plan in addition to the Original Medicare Plan or other types of medical coverage.
Medigap Policies
Medigap Policies, also called Medicare Supplement Insurance, are types of insurance coverage supplied by private companies to help Medicare participants acquire coverage not provided by other programs, such as the Original Medicare Plan, in exchange for a monthly premium. Medicare recipients who have a Medicare Advantage Plan don't also need a Medigap Policy, however.
Considerations
Deciding on the right combination of Medicare plans can seem daunting because Medicare participants are given complete freedom to select what works best for them based on their income, medical conditions, preferred health care and prescription provider, and current drugs prescribed. Yet an advantage of the system is that each year, Medicare recipients are allowed to choose a different combination of programs if they want to.
Tags: Medicare Plan, Original Medicare, Original Medicare Plan, health care, Medicare Advantage, Medicare participants, Plans Medicare