What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Different options for Medicare beneficiaries

  1.  Stay with Original Medicare
  2.  Medicare Advantage
  3.  Medicare Supplement
  4.  Medicare Part D

Original Medicare

Medicare Part A and Medicare Part B are often referred to as Original Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service.

Medicare pays 80% the approved amount, and the person with Medicare pays the remaining 20% plus the deductibles.

The deductible for part A is $1288 and the deductible for part B is $166.

Medicare Advantage

Medicare Advantage is a United States health insurance program of health care that serves as a substitute for “Original Medicare”. Parts A and B Medicare benefits also called the Part C. The Part C includes the Part A, Part B, in most cases the Part D and other extras.

Medicare Advantage Generally, is a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan.

Different types of Medicare Advantage Plans

HMO Plans

In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor.

PFFS Plans

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C)offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.

Medigap

A Medicare Supplement Insurance (Medigap) policy, sold companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

PPO Plans

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C)offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network . You pay more if you use doctors, hospitals, and providers outside of the network

Medicare SNPs Plans

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

Medicare Part D

Medicare Part D, also called the Medicare prescription drug benefit, is States federal-government program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

How to choose the best Medicare plan for you?

Every individual is different with different needs. NO individual plan is best for everyone. These are very important questions to ask:

  1.  Can I see any Doctor or Specialist I want?
  2.  Do I have to buy a Part D plan?
  3.  Are my drugs covered under the plan’s
  4.  Does my plan cover me when I travel?
  5.  How much are your premiums, deductibles, and other costs?
  6.  Do I have dental benefits with the plan?
  7.  When can I enroll in this plan?
  8.  If I am dissatisfied, can I dis-enroll?
  9.  Do I qualify for extra help?
  10.  What is my maximum out of pocket in this plan.

Take the next step

Speak with a TRS Professional Advisor about your goals