Medicare Supplement Insurance Plans
Terms and Definitions Provided by a Medigap Representative
As you investigate Medicare supplement insurance plans, you’ll come across certain terms whose definitions you’ll want to know. Here’s a list of key terms and definitions to help you become familiar with the language of Medicare and Medicare supplements.
Concerning Medicare
Original Medicare is coverage under which the government pays health care providers directly for your Part A and Part B benefits.
Medicare Cost Plans provide for qualified payment under Original Medicare when medical services are received outside the plan’s network without a referral.
Medicare Prescription Drug Plans (Medicare Part D) add prescription drug coverage to Original Medicare and various other plans. Part D plans are offered by insurance companies and other Medicare-approved private companies.
Medicare Advantage Plans (Part C) are offered by private companies contracting with Medicare to provide Medicare Part A and Part B benefits. Most Medicare Advantage plans offer Medicare prescription drug plans (Medicare Part D).
Concerning Medicare Advantage
Medicare Private Fee-for-Service (PFFS) Plans generally allow you to visit any doctor or hospital Original Medicare would allow you to visit, as long as the doctor or hospital agrees to treat you. A PFFS plan can require you to follow strict rules, and determines how payments are to be divided between the PFFS and the patient.
Health Maintenance Organization (HMO) Plans normally require referrals from primary care physicians and treatment by specialists and hospitals within the plan’s network.
Medicare Preferred Provider Organization (PPO) Plans allow you to use doctors, hospitals, and providers outside the plan’s network at additional cost.
Medicare Medical Savings Account (MSA) Plans deposit Medicare funds into an account used for paying your health care costs. MSA plans normally come with high deductibles resulting in out-of-pocket expenses before coverage begins.
Medicare Special Needs Plans (SNPs) provide focused, specialized health care for specific groups of people including beneficiaries of both Medicare and Medicaid, those in nursing homes, and those with certain chronic conditions.
Concerning Your Rights
Guaranteed Issue Rights (or Medigap Protections) spell out conditions under which insurance companies can neither deny you a Medigap policy nor place conditions on such a policy.
Guaranteed Renewal, attached to every Medigap policy issued since 1992, stipulates that an insurance cannot terminate your policy unless you’ve made a false statement to the company, committed fraud, or failed to pay your premiums.
Open Enrollment is a one-time-only, six-month period beginning the first month you’re covered under Medicare Part B and are 65 or older. During your open enrollment period you can purchase any Medicare supplement plan sold in your state regardless of past or present health problems.
Now that we’re speaking the same language, we hope to hear from you. Contact MedicareMall now so we can answer any questions you may have and help find the Medigap plan that’s best for you.