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Medicare Basics

Medicare Supplement Plans

Medicare supplement plans help pay for gaps in Original Medicare. These include minimal standard coverages, offer different enhanced coverages, and are approved by each state in which they are offered.

Medicare Advantage Plans (Part C)

Medicare advantage plans work like HMO or PPO health plans. They limit out-of-pocket expenses every year and require you to stay in-network for services. These plans sometimes include prescription coverage.

Prescription Drug Plans (Part D)

Prescription drug plans have a Formulary or List of Covered Drugs. Only Formulary drugs count as an out-of-pocket. Include three levels of covered expenses, and sometimes included in Medicare Advantage.

Medicare Details

Due to the amount of out-of-pocket payments required by traditional Medicare, a booming market of private sector insurance products has grown up around the goverment programs. These Medicare-related insurance programs are one of the fastest growing segments of the U.S. health insurance industry, and are part of the market on which a smart consumer should focus his or her attention. Choice Medicare Plans' goal is to help seniors understand these products and provide tools to assist in your decision-making process.

The market for private sector Medicare-related coverages can be described as:

  • A Group of Medicare Supplemental Plans - Sometimes referred to as "Medigap" insurance. This type of coverage, to varying degrees, can cover the things traditional Medicare does not.
  • Medicare Part C Plans - These plans replace traditional Medicare with any of several managed-care style programs that require little or no out-of-pocket payments.
  • Medicare Part D Plans - These plans cover the cost of outpatient prescription drugs and supplement either traditional Medicare or, in some cases, a Part C managed-care plan.

In order to qualify for most Medicare-related programs, you must meet the standard Medicare eligibility requirements and live in the geographic service area.

Medicare-related plans are regulated by each state and approved for sale within geographic service areas. In most cases, these areas are organized on a county-by-county basis. In some large urban markets, they are organized on a city, or even neighborhood, basis.

If you move out of your geographic service area during a plan's coverage term, you will usually have a Special Enrollment Period that allows you to enroll in another Medicare-related plan approved for sale in your new location, or switch back to traditional Medicare.

The number of Medicare Supplement, Part C and Part D plans available to you in a given area can be overwhelming. In some counties, there are at least 380 Supplement and Part C options available, and at least 64 Part D prescription drug options. This means you will have a veritable menu of over 400 plans from which to choose.

Combine those numbers with the fact that the Federal government isn't keen on making consumer information readily available, and in an easy-to-use format, and you have a recipe for confusion. It is more than most people want to know about health insurance, but the purpose of this web site is to give you the tools and information you need to make a sound decision.

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