Medicare Insurance – pelours

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Medicare Insurance

There are countless rules and regulations governing employee benefit plans, many of which are complex.

A

Hospital Insurance

Inpatient hospital, skilled nursing, hospice, home health
$0 premium for most; deductible/coinsurance applies

B

Medical Insurance

Doctor visits, outpatient care, durable medical equipment. Monthly premium, deductible, and 20% coinsurance.

C

Medicare Advantage

All A+B services, often drug coverage (Part D), extras (dental/vision). Varies by plan; often $0 or low premium; copays/coinsurance.

D

Prescription Drugs

Prescription medications Monthly premium, deductible, and copays.

Medigap

Medicare Supplement

Gaps in A & B (deductibles, copays). Monthly premium to private insurers.

Medigap (Medicare Supplement) Plan Comparison

Medigap plans are standardized with letters (Plan A, B, C, D, F, G, K, L, M, N), where plans with the same letter offer the same benefits

Best for Lowest Out-of-Pocket: Plans F and G (Plan G is for new enrollees) cover the most, including Part B excess charges.
Best for Lower Premiums: Plans K, L, and N offer lower premiums but higher cost-sharing.
Key Coverage: All Medigap plans cover Part A coinsurance, but only some cover the Part B deductible or foreign travel emergencies.

Medicare Advantage (Part C) Plan Types

HMO (Health Maintenance Organization): Typically restricts care to in-network providers, requiring referrals for specialists.
PPO (Preferred Provider Organization): Allows in-network or out-of-network providers (at higher costs), no referrals needed.

PFFS (Private Fee-for-Service): Determines how much to pay doctors; providers must accept plan terms.
SNP (Special Needs Plan): Tailored for specific chronic conditions or financial situations.

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