by Joseph Doratan
Having just the Original Medicare card is not enough. It does not cover the cost-sharing like deductibles, co-pays and 20% co-insurances. It does not cover prescription drug. It does not have worldwide coverage.
One way to complete the Medicare puzzle is to add a Medicare Supplement plan (Medigap) from work or private insurance to defray these cost-sharing AND to add a Prescription Drug coverage (Part D). This means 2 more cards, total of 3 cards. These 2 additional cards have monthly premiums.
Medigap comes in several plans: Plan A, C, N, K, F, etc. Different insurance companies offer different plans. But all plans are standardized. For example, Plan F from different companies have uniform benefits. Most plans offer 365 more hospital days than Original Medicare. All these plans differ fundamentally in how much cost-sharing they cover and if worldwide coverage is included. In general, the more expensive plan covers more. Among the plans, Plan F covers the most. People who use plan F typically does not have any co-pay.
People who use Medigap can see any provider accepting Medicare without referrals.
Part D plans vary according to premiums and formularies. To find out the most cost-effective plan, the list of medications has to be matched up with the Part D plans.
Another way to complete the puzzle is to have Medicare Advantage (Part C), serving all the benefits of Parts A and B, helping cover the cost-sharing, offering worldwide coverage and in most cases including the Part D, all-in-one card to show the providers and pharmacies. This 1 card may have $0 or more monthly premium.
Different Part C plans offer different benefits. They may include worldwide coverage, dental, vision, transportation services, etc. Part C can be PPO or HMO. But either way, people can only use doctors within the plan’s network. For HMOs, primary care doctors (PCPs) serve like the hub giving referrals to specialists and other providers.
Deciding on which Part C to use normally begins with checking if one’s PCP is within the network, the hospital list and if one’s drugs are covered.
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