How to Know Which Medicare Insurance You Have
Recently, my brother, Jeff Jones, who works with me at our offices on Market Street, made an interesting observation. With all the many names given to Medicare private insurance plans, it is difficult to decipher what type of plan covers a senior individual.
Jeff knows what he is saying. As a Certified Senior Advisor whose business, Life Transitions Services, LLC, has for the past seven years specialized only in work for seniors, he has poured over multiple insurance documents. Even with the almost 14 years that I have limited my practice to this field, I still see why there is confusion.
Take, for example, the names. There is nothing about names such as Secure Horizons©, Advantra Freedom©, or Personal Choice 65© to tell whether the plan is a Medicare Advantage, Medicare Supplement or PFFS plan.
When clients arrive at the office not knowing what kind of Medicare plan they have, we ask further questions to sort it through with them.
With the Medicare Advantage and Medicare “D” “open enrollment” period having begun again on November 15 to run through December 31, it seems a good time to give readers a simple, easy to follow “road map” to understand their Medicare insurances.
Follow this summary as you read through insurance brochures and Web sites and you will have a much better understanding of the choices
First. Ignore the name of the plan. Look for the type of plan first.
Ignore the name of the company. Most major carriers now carry several types of plans.
The important distinction now is to look for the words “Medicare Advantage,” or “PFFS,” or “Medicare Supplement” (“Med Supp” for short), or “Medigap” or Basic Medicare. Until you have found those words, you will not be able to determine what you have.
Medicare Advantage is the newer name for Medicare HMO except that now there are also Medicare Advantage PPO’s.
PFFS or Private Fee for Service plans are a type of Medicare Advantage.
Medicare Supplement, Med Supp or Medigap all refer to a plan that supplements the basic Medicare benefit.
Basic Medicare is the government program without any private insurance plan.
Here are the differences and why you should care.
Second. Know the differences in cost, coverage and benefits.
If you have a Medicare Advantage plan, you likely pay less than with a Medicare Supplement. The plan may be advertised as providing health insurance and prescription coverage in one. Some Medicare Advantage plans come “loaded” with dental and vision coverage. Many do not. If the plan is an HMO, you may need referrals to doctors. If it is a PPO, you may not. The plan might or might not cover what basic Medicare covers. It is more likely that a doctor or hospital or nursing home might refuse to accept coverage from a Medicare Advantage plan, especially a PFFS plan, than with a Medicare Supplement.
If you have a Medicare Supplement or “Medigap” plan, you likely will pay more for coverage than with a Medicare Advantage plan. You will know exactly what coverage you have because the plans are standardized. If you have a plan that comes with letters – they run A through L – it is probably a Medicare Supplement. The only major difference between one Plan J with one insurer and another Plan J with another insurer is usually cost. Doctors and hospitals generally prefer Med Supp plans and the plans typically “travel” better than many Medicare Advantage plans if you move to another State. Med Supp plans do not have the deductibles and co-pays and do not require referrals that may be necessary with some Medicare Advantage plans.
Prescription Drug Coverage. Medigap plans can no longer cover prescription drugs. This was a change effected by the Medicare Modernization Act. If a Medigap policyholder wants prescription drug coverage, she must buy it through a separate plan known as a PDP that usually can be purchased through the same insurance company that offers the Medigap plan.
Third. Know where to go for help. Chester County has an excellent free resource through volunteers with the APPRISE program with Department of Aging Services to counsel seniors with questions on Medicare coverages. The voice mailbox for APPRISE is 610-344-5004. Their volunteers are some of the brightest people I know in this area. The federal government web site is www.medicare.gov. Medicare Advantage is referred to as “Medicare Health Plans” and Medicare Supplements as Medigap. Medicare Advantage plans and companies but not Medicare Supplement companies are listed.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.