Medicare Supplements, Prescription and Advantage Plans


Medicare Plan Details


Medicare Advantage Plans (Part C)

A type of Medicare health plan by a private company that contracts with Medicare. Medicare advantage Plans provide Part A and Part B benefits. If you're enrolled in a Medicare Advantage Plan: Most Medicare services are coved through the plan. Medicare services are not paid for by Original Medicare.

Most Medicare Advantage Plans offer prescription drug coverage. Some may provide limited benefits for vision, dental, and hearing.

  • Health Maintenance Organization (HMO) Plans
    Generally, must get your care and services from doctors, other health care providers, or hospitals in the plan's network. Primary Care Physician required and referrals made by primary care physician to see specialist. Most services outside of the network are not paid (except emergency care).
  • Preferred Provider Organization (PPO)
    PPO plans have network doctors, other health care providers, and hospitals. You can use out-of-network providers for covered services, usually for a higher cost.
  • Private Fee-for-Service (PFFS) plans
    PFFS plans aren't the same as Original Medicare or Medigap. You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to treat you. If you join a PFFS plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan's terms, but you may pay more.
  • Special Needs Plans (SNP)
    Generally, must get your care and services from doctors, other health scare providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of area dialysis).
  • HMO Point-of-Service (HMOPOS) Plans
    Generally, receive care from plan network providers without referral of primary care physician. Benefits may very from HMO and or PPO plans.



Medicare Supplement (Medigap) Plans

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles.

Plans offering a supplemental policy in fill "gaps" in Original Medicare coverage. A Medigap policy typically pays some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare, such as care outside of the country. These plans are not affiliated or connected to Original Medicare.

Medigap Policies Are Standardized
Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as "Medicare Supplement Insurance." Insurance companeis can sell you only a "standardized" policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Starting January 1, 2020, Medigap plans sold to new people with Medicare won't be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible verison of Plan F) or are covered by one of these plans before January 1, 2020, you'll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.

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