Part A

Part A covers hospice care, home health care, skilled nursing facilities, and inpatient hospital stays.

Enrollment is automatic when you become Medicare-eligible.

There is no premium for Part A if you have paid more than 10 years of payroll taxes through your employer.

Part B

Part B covers physician fees, outpatient hospital care, some preventative services and therapies, diagnostic tests, durable medical equipment, and other medical services not requiring hospitalization.

You must choose to enroll. A premium penalty is applied if you do not enroll when you first become eligible for Medicare.

Yes. Beneficiaries with Social Security Administration withhold the monthly premium for 2010 will be $96.40.

 

$110.50 for all others.

 

*high income premium rates apply.

Medigap

Medigap is Medicare supplemental insurance sold by private insurance companies to fill “gaps” in original Medicare Plan coverage. There are 12 standardized plans labeled ‘Plan A-Plan L’. Medigap policies only work in conjunction with the Original Medicare Plan. There is no prescription drug coverage included in a Medigap policy due to the availability of Part D.

Enrollment is voluntary.

Yes, you will pay a monthly premium to the insurance company you choose.

Part D

Part D covers generic and brand-name prescription drugs included in the plan’s formulary, which is a list of drugs the plan will pay for.

Enrollment is voluntary. A premium penalty is applied if you do not enroll when you first become Medicare-eligible.

Whether you pay a Part D premium, deductible or co-insurance depends on the plan you choose, as each Part D plan has different cost-sharing structure. Depending on plan, you may pay both a monthly premium and a share of the cost of your prescriptions.

Part C

Medicare Advantage Plans are health plan options that are part of the Medicare program. These plans are approved by Medicare and run by private insurance companies. If you join one of these plans, they provide all of your Part A and Part B coverage. They generally offer extra benefits, and many include prescription drug coverage. Medicare Advantage (MA) Plans include:

When you join a MA Plan, you use the health insurance card that you receive from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. Some of these plans require referrals to see specialists.

 

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your MA Plan for the extra benefits they offer.

Private Fee-For-Service

(PFFS)

A type of Medicare Advantage Plan that provides beneficiaries with all their Medicare benefits plus any additional benefits the MA plan decides to provide. One major difference between a PFFS plan and other MA plans is that, in most cases, people who join a PFFS plan are not required to use a network of providers. Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS plan.

Enrollment is voluntary.

Each Medicare Advantage Plan sets its own premium, deductible and co-insurance. In addition, you must continue to pay your Part B premiums.

Preferred Provider Organization (PPO)

A type of Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Enrollment is voluntary.

Each Medicare Advantage Plan sets its own premium, deductible and co-insurance. In addition, you must continue to pay your Part B premiums.

Health Maintenance Organization (HMO)

A type of Medicare Advantage Plan that is available in most areas of the country. Plans must cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits, like extra days in the hospital. In most HMOs, you can only go to doctors, hospitals, and specialists on the plan’s list except in an emergency. Your costs may be lower than in the Original Medicare Plan.

Enrollment is voluntary.

Each Medicare Advantage Plan sets its own premium, deductible and co-insurance. In addition, you must continue to pay your Part B premiums.