Medicare Part A, Part B, and Medicare Advantage Plans

Article submitted by Seniors First.
For more information about Medicare Advantage plans in Mobile or Baldwin Counties, they can be reached at 1-888-212-5475.

There seems to be a lot of questions about Medicare limits and coverage, and about different types of Medicare plans. Perhaps this simplified explanation will be helpful in understanding your benefits.

Medicare Part A, (Hospital Insurance): Most people do not pay a monthly Part A premium because they or a spouse have 40 or more quarters of Social Security covered employment. Part A covers hospital care, home care and hospice.

Medicare Part A is Funded by social security taxes and Medicare taxes.

Reimbursement is through Medicare intermediaries; payments are based on per episode per diagnosis.

Medicare Part B, (Medical Insurance). Premium, $78.20 per month. Participants pay 25% of costs and general taxes pay 75% of costs. The Medicare Supplemental Trust Fund also pays part of this. Coverage includes physician visits, PT and OT, mental health, lab, X-Ray, and durable medical equipment. Medicare pays 80% of Medicare-covered services after a $110 deductible; you are responsible for 20% co-insurance.

What are Medicare Health Plans?

Medicare health plans provide different ways to get your health care coverage in the Medicare program. The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare health plan choices are the Original Medicare Plan or Medicare Advantage Plans.

The Original Medicare Plan is available nationwide. If you get your health care from the Original Medicare Plan, you use your red, white, and blue Medicare card. The Original Medicare Plan pays for many health care services and supplies, but it doesn't pay all of your health care costs; there are costs that you must pay, like coinsurance and deductibles. These costs are called "gaps" in Medicare coverage. You might want to consider buying a Medigap policy to cover these gaps in Medicare coverage. For additional information on the Original Medicare Plan, visit the Original Medicare Plan section of our website, www.medicare.gov.

Medicare Advantage (formerly Medicare + Choice) Plans are available in many areas. To join a Medicare Advantage Plan, you must have Medicare Part A and Part B, and will have to pay the monthly Medicare Part B premium of $78.20 (in 2005) to Medicare.

Medicare Advantage Plans include Medicare Managed Care Plans, Medicare Preferred Provider Organization Plans (PPO), Medicare Private Fee-for-Service Plans, and Medicare Specialty Plans. You don't need a Medigap policy with these plans. With a Medicare Advantage Plan you will use the health care card that you get from your Plan provider. These plans often give you more choices and extra benefits like extra days in the hospital, prescription drug coverage, transportation, eye glass coverage with small co-payments. Some plans have no premium and some require a monthly premium payable to your provider.

Source: http://www.cms.gov