This is the time of year that individuals can switch their existing health or Rx plan for another companies plan. Open enrollment started on November 15, 2007 and will close on December 31st, 2007 . If you are not age 65, but have received your Red, White and Blue card, you can also enroll at this time. For individuals turning age 65 later in 2008, you will receive the same Red, White and Blue card approximately 30-60 days before your birthday. You will have an open enrollment period at that time. Then you will only be able to switch once a year.
There are a number of no cost programs, as well as moderately priced Medicare supplemental health insurance plans available to individuals receiving Medicare Benefits. Let review the basics.
First, the Original Medicare Plan:
This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
The Original Medicare Plan is a fee-for-service plan managed by the Federal Government. In general, with the Original Medicare Plan:
- You use your red, white, and blue Medicare card when you get health care.
- You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
- You pay a set amount for your health care (a deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (your coinsurance or copayment) for covered services and supplies (unless you have a Medigap policy or other supplemental insurance that may pay for these costs.)
- You may have a Medigap policy or other supplemental coverage that may pay deductibles, coinsurance, or other costs that aren’t covered by the Original Medicare Plan.
Medicare Health Plans (like HMOs and PPOs)
These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan, but it is important to check with the plan because the costs for services will vary.
Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare. With Medicare Advantage Plans:
- Some of the plans require referrals to see specialists.
- In many cases, the premiums or the costs of services (co-pays and deductibles ) can be lower than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy. Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
- The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
- They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
- They generally offer extra benefits, and many include prescription drug coverage.
- In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
- Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
- You don’t need to buy a Medigap policy.
Medicare Health Plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS) Plans
- Medicare Medical Savings Account (MSA) Plans
- Medicare Special Needs Plans.
Medicare Prescription Drug Plans
These plans add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare. They add coverage to:
- The Original Medicare Plan
- Some Medicare Cost Plans
- Some Medicare Private Fee-for-Service Plans, and
- Medicare Medical Savings Plans.
With a Medicare Prescription Drug Plan:
- 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 co-payment, coinsurance, and/or deductible, if any.
If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs.
If you want to compare Medicare Prescription Drug Plans, use the Medicare Prescription Drug Plan Finder.
Medigap (Medicare Supplement Insurance) Policies
These policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan, you could get a Medigap policy to help cover the extra health care costs.
Medigap policies are health insurance policies sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. In general, with a Medigap policy:
- You get help paying for some of the health care costs that the Original Medicare Plan doesn’t cover.
- You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
- You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.