Medicare


Medicare

Medicare is a health insurance program for people 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure).

The plans below offer additional coverage.

 

Medicare Supplement or “Medigap” Plans

  • Have the highest monthly premiums (premium goes up with age each year)
  • Medicare Supplement plans pays secondary to Medicare
  • Offers the most extensive “network” (go to any doctor or hospital nationwide that accepts Medicare)
  • Offers the highest protection and lowest out of pocket cost to the member (Plan F has no co-pays and no medical out of pocket cost to the member)
  • Plans do not include prescription coverage. Requires member to purchase an additional separate Part D drug plan
  • Member carriers and uses three cards (Medicare card, Medicare Supplement card and Part D prescription card)
  • Plans do not offer additional benefits like routine eye exam or routine dental cleanings
  • Silver Sneakers are not part of program (unless specified by the Supplement carrier)

Medicare Advantage Plans

  • Have the lowest premiums (many of the HMO plans offer zero monthly premium)
  • Plan pays in place of Medicare (do not use your Medicare card)
  • Benefits may change each year
  • Have networks that members must utilize (either HMO or a PPO style plan)
  • Have co-pays and member out of pocket costs for most services
  • Most plans include the Part D drug coverage for no additional premium
  • Plans may offer extras like routine eye exams and routine dental cleanings
  • Almost all plans include Silver Sneakers fitness benefit
  • HMO plans offer the lowest monthly premiums and the lowest out of pocket costs but restrict coverage to in network doctors and hospitals only (all HMO plans are required to cover you for emergencies or urgent care in or out of the network)
  • Some HMO plans require referrals to see specialists
  • PPO plans usually have higher monthly premiums than HMO plans but give more freedom to choose doctors
  • PPO plans allow the member to see doctors in or out of the network

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