We have already covered Medicare parts A and B. Now we’ll tackle Medicare Parts C and D.
Medicare Part C and Medicare Part D are not included in the basic body of the Medicare that automatically flutters into your Social Security check once you turn 65. They are more like options and definitely warrant a closer inspection and dissection. After the relative straight-forwardness of the first two parts, C and D may be the bits that need a microscope.
Now, as we look though our magnifying lens we learn that despite its name, Medicare Part C is actually not the same thing as Part A and Part B. It is its own creature only similarly named. It also goes by the name of Medicare Advantage and it is a private insurance replacing the original Parts A and B but offering at least the federal regulated coverage of those Parts plus some extra. If you choose Part C (which is not a ‘Part’ at all) you lose the first combined A and B monster and end up with a whole new one you bought from someone other than the federal government.
What’s the Difference?
By choosing to go with the original Medicare Monster, Parts A and B, as offered directly from the government, you will need what is known as Medigap insurance to pick up the slack in certain areas.
If you choose to enroll privately in Medicare Advantage you refuse the original plans but receive the same coverage and Medicare Advantage (Medicare Part C) automatically picks up the slack that Medigap insurance does, meaning you do not need both Medigap insurance and Medicare Part C. They accomplish close to the same thing. Generally speaking, a Part C plan, which is still federally regulated even though privately owned, is a lower cost plan with slightly broader coverage. However, each private insurance company will offer different packages; there is no standard only a minimal, so each Medicare Advantage plan needs to be considered individually.
For Medicare Advantage there are enrollment periods; most don’t offer a jump-in-at-any-time process. Some do, but all must be accepting new enrollees at the time to be considered. There are two different breeds of Plan C:
- Managed care
Managed Care plans are the HMO, PPO types which deal with networks of doctors who are willing to see patients on this insurance. Basically, you enjoy full medical coverage only if you choose a doctor in your network, which means you could be losing your doctor of 20 years. It’s the least expensive and most common kind of coverage, but also rather limited. Fee-for-service offers more variety in theory and works outside of a network system but only covers those doctors who have agreed to accept the fees and payments offered by the plan. If they choose not to then they are not covered.
Also, it should be understood that many Medicare Advantage plans offer limited coverage and if you travel a lot or visit the grandkids often in another state, your coverage may not go with you. It tends to stick to the region in which you live, so any non-emergency bills you acquire out visiting may be out-of-pocket expenses. There is a possibility that your doctor does not operate under the Medicare Advantage plan, too. Always check to see if he or she is familiar with the plan you are considering or you may lose that doctor. Never forget to check deep with any plan to find where their coverage lies regarding specialists and specialized care. The Medicare Advantage plan you’re looking into may not find your specialist necessary and therefore not cover a trip to her. Likewise, specialized care such as physical therapy or home healthcare may not be covered even if prescribed by your primary doctor.
The worst outcome of a Medicare Part C plan is the possibility that you could, at any time, lose coverage completely if the private insurance company you are going through decides to pull out of that region. This happens if the company is not making enough profit to sustain coverage in that area and then, having refused your federal coverage, you’ll be left scrambling to find the coverage you desire. There are a few options out there, most of them include finding another provider that covers your region, but it can be frightening to go without insurance when you really need it. Medicare Advantage plans are not guaranteed coverage at all times.
Back to the First
To make an informed decision we need to know how both options work so we turn back to the original Medicare Monster to see how it performs with Medigap coverage instead. Also offered by private insurers, this plan allows you to keep your original 65th birthday gift from the federal government. Part A and B cover only half of all the expenses seniors accrue along the way and Medigap covers a good deal of the rest like a bridge over troubled insurance waters.
There are 10 plan types as of June 2010:
- Plans A-D
- Plans F-G
- Plans K-N
Plans I, E, H and J are no longer available for those who did not buy them before June 2010. Each of these plans gives specific coverage, a base line that is federally mandated and must be included. That does not change by policies. Aside from that, each of the 10 has differences and variety enough that all should be reviewed by the senior looking for the coverage. Premium costs, size of premiums and when coverage begins may all vary by plan and provider. Once you have decided which of the 10 suits you best, make sure you spend the time to read the fine print. Really dig into the plan, dissect it. Those residents of Minnesota, Wisconsin or Massachusetts will find their Medigap insurance comes in different categories with some possible additional benefits.
Every plan type in all Medigap insurance policies will include three basic points:
- Each policy will pay the Part A coinsurance amounts for hospitals plus the complete cost of up to 365 additional hospital days after the coverage is exhausted.
- Each policy will pay all or some of the cost of the first three pints of blood required for a transfusion, something Medicare does not pay.
- Each policy will cover all or a part of the Part B 20% coinsurance amount for outpatient care and doctor bills, the amount of which varies between plans.
Points to Consider
With 10 different policies to slug through, you may find yourself overwhelmed. There’s no way to go through the fine points of each one but there are a few things to consider when making a choice.
- Do you travel? If so, you may wish to consider plans C, D, F, G, M or N, which offer some emergency medical coverage outside the United States.
- Do you have a chronic or serious condition? If you are looking at high, ongoing costs perhaps plans K or L will work better for you. Plan K pays only half the costs and plan L pays 75%, but these two come with a yearly out-of-pocket expense cap that can save you a great amount. (The cap for Plan K is greater than for Plan L but premiums may be a factor.) However, after these caps are reached the plan covers 100% of the expenses.
- Does your doctor charge an excess? Some doctors can charge a 15% fee above the Medicare covered fee for a doctor visit. Most doctors accept what Medicare pays as an assignment fee but if you regularly see one of those who does not and adds an extra amount, then Plans F or G might be your ticket. They pick up that added expenses at the cost of higher premiums.
A rule of thumb to follow is that policies offering more coverage will also cost more, but shop around when it comes to providers. Premiums vary wildly within the industry and since this policy is one you might own for a long time, it’s best to minimize financial leakage.
Part D, which deals with prescriptions, will be dissected in the next installment.