Medicare Plan Options: Medicare Advantage, Original Medicare and Prescription Drug Plans

Congress added Medicare Advantage plans (Part C) as an alternative to Original Medicare (Parts A and B) to give beneficiaries more choices about how they receive their health care coverage. Original Medicare is administered by the federal government. Medicare Advantage plans are offered by private insurance companies that have been approved by Medicare. Deciding whether to select a Medicare Advantage plan or Original Medicare is the first step when enrolling in Medicare.



Medicare Advantage vs. Original Medicare



Medicare Advantage plans combine the coverage of Medicare Part A (hospital visits) with the coverage of Medicare Part B (doctor and outpatient visits) into one plan package, and they must cover all the services that Original Medicare does. The one exception to this is hospice care, which is still covered by Original Medicare. People who opt for a Medicare Advantage plan can still receive hospice care, too.



Companies that offer Medicare Advantage plans have flexibility with regard to the services they cover beyond what Original Medicare covers. Some plans bundle coverage for dental, hearing, vision and wellness services into their offerings, and many have built-in prescription drug coverage or offer it as an optional add-in. People who opt for Original Medicare need to purchase a separate, standalone Prescription Drug Plan if they want help with the cost of their medications.



Several kinds of Medicare Advantage plans are available. In some, care is coordinated through a primary care provider, and beneficiaries may have to choose from a specific list of doctors and hospitals. These include Health Maintenance Organization (HMO) plans, Point of Service (POS) plans, Preferred Provider Organization (PPO) plans and Special Needs plans (SNP). In other kinds of Medicare Advantage plans, you can receive care from any doctor or hospital that will accept the plan’s terms, conditions and payment rates each time they provide a covered service. These include Private Fee-For-Service (PFFS) and Medical Savings Account (MSA) plans.



Prescription Drug Plans



Medicare Prescription Drug Plans (Part D) help pay for the medications your doctor prescribes for you. These plans are offered by private insurance companies and you must buy the coverage in order to receive the benefit. You can get prescription drug coverage through a standalone drug plan or as part of some Medicare Advantage plans.



You may choose to combine a standalone Prescription Drug Plan with Original Medicare or with a "non-coordinated care" Medicare Advantage plan, such as a PFFS or MSA. However, if you opt for a Medicare Advantage plan that provides coordinated care, such as an HMO, and you want drug coverage, then you must get it through your plan. You cannot buy, and should not be sold, a standalone Prescription Drug Plan if you also have a Medicare Advantage plan that provides coordinated care.



Every insurance company must follow federal guidelines and minimum standards regarding the types of drugs they cover in their Medicare Prescription Drug Plans. But each company decides which specific drugs will be covered and which pharmacies plan members may use. Each company also negotiates its own prices with drug manufacturers and sets its own member cost-sharing terms for copays, coinsurance and deductibles. So it’s important to shop around for the plan that meets your needs and your budget.



For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact the UnitedHealthcare® Medicare Made Clear helpline at 1-877-619-5582, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week for information regarding your UnitedHealthcare® Insurance Company Medicare options.



The family of UnitedHealthcare® Medicare Solutions plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization with a Medicare contract and Medicare-approved Part D Sponsor.



Additional Resources



http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-c.aspx



http://www.medicareadvocacy.org/InfoByTopic/Reform/Reform_09_01.22.RulesforCandD.htm



http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx



http://www.medicaremadeclear.com/Understanding-Medicare/Part-C.aspx



http://www.medicaremadeclear.com/Understanding-Medicare/Part-D.aspx



http://www.medicaremadeclear.com/Understanding-Medicare/Medigap.aspx



http://www.medicaremadeclear.com/Making-Choices/Compare-Costs-and-Coverage.aspx



http://www.youtube.com/watch?v=x91_3ocJ3XY



http://www.youtube.com/watch?v=8cfAbG9EFH4



http://www.youtube.com/watch?v=QoFBShKG9fA





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