If you’re approaching age 65 or already have basic Medicare, you know that the enrollment options can seem overwhelming. Many people just choose Original Medicare at first and figure they can change their enrollment choice when enrollment is open again.
Let’s break down your various Medicare options to help you decide what may be your best choice, and how you can best manage your money and live a healthy and full lifestyle.
What Is Original Medicare?
Original Medicare is what most people are familiar with. It’s the government-based healthcare coverage for people who are age 65 and older, or for individuals who have certain health conditions and life circumstances.
Original Medicare has two parts: Part A, which covers hospitalization, and Part B, which covers doctor’s visits and other kinds of outpatient health-related services. Coverage is not usually complete coverage of your medical bill but rather partial coverage.
Part D is optional coverage for prescription costs, and it is under a separate Medicare plan. This is a separate benefit and is not considered part of Original Medicare.
What Is Medicare Advantage?
Medicare Advantage is a combination plan, offered by a private insurance provider, that generally offers a more comprehensive package of coverage. It covers the same things as do Medicare Parts A and B, plus other benefits, and it is usually a bit more expensive.
Also called Medicare Part C, Medicare Advantage plans are administered by major health insurance companies such as Blue Cross Blue Shield, Aetna, and UnitedHealthcare. These companies have contracts with Medicare to be Medicare Advantage providers, and they must follow certain standards.
Medicare Part C generally features lower out-of-pocket costs and extra coverage for hearing, vision, prescription costs, and more. Part C plans fall into distinct categories: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS), and Special Needs Plans (SNPs):
- HMOs provide a wide range of medical services through a network of doctors who work for or are contracted by the Health Maintenance Organization itself. HMOs stress preventive care to keep medical costs as low as possible. This is a cheaper and less flexible option than a PPO.
- PPOs are similar to HMOs in how they deliver care. However, unlike a Health Maintenance Organization, a Preferred Provider Organization does not require a patient to have one particular primary care doctor or to get a referral to a specialist. You can usually see a specialist on your own, without a referral by a primary doctor.
- With Private Fee for Service, the patient may or may not have drug coverage (and so they must obtain Medicare Part D if they want prescription medication coverage). PFFS subscribers also must pay their doctors’ fees as set by their plans. Out-of-pocket costs may be higher in some cases.
- Special Needs Plans (SNPs) are available only to a certain kind of Medicare Parts A and B eligible patient. For instance, a person may join an SNP if he or she has a chronic health condition, such as dementia or congestive heart failure. Having to live at least 90 days in a nursing home, psychiatric hospital, or other long-term care facility is another qualifier. People who receive both Medicaid and Medicare also may be served under an SNP.
Trusted Medicare Provider in Central Florida and South Florida
Here at Palm Medical Centers, our comprehensive medical care team provides diagnosis and treatment of acute disease and injury, along with the finest medical management of chronic health problems. Prevention, quality of life, compassionate care, and complete communication are at the heart of all we do.
We also help our senior patients navigate their Medicare choices and benefits. Our patient relations representatives are Medicare experts, including in the application process.
We have 23 convenient locations throughout the state. Call us today to arrange a consultation at (833) 500-PALM (7256), or fill in our new patient form online. We look forward to being your healthcare partner!
