Medicare Advantage

Part C is a Medicare Advantage plan. In California, these are typically HMO plans, however, they can be PPO plans also. These plans are considered managed care, where you pick a Primary Care Physician, who belongs to one or more networks. You pick which network you want to work within. Once you’ve picked your doctor and start using the plan, you may have to get referrals to doctors and stay within that network. If you choose to go out of network, then you won’t have any coverage with the HMO’s. If you’re on a PPO, you can go out of network, by you’ll pay more for services. With Medicare Advantage plans, you have deductibles and copays as you use the plan.

Medicare Supplement

Medicare Supplement Insurance (Medigap) plans are not HMO or PPO plans. Medicare Supplement Insurance plans are secondary to Medicare, who’s primary and pays your claims first typically. The Medicare Supplement Insurance plan can also pick up your deductibles and coinsurance that Medicare doesn’t pay. There are various standardized plans available. These plans are guaranteed renewable, which means the insurance company can’t cancel your Medigap policy as long as you pay the premium. Unlike the Medicare Advantage plans, which can change from year to year and can even go away. These plans do not cover the medication you pick up at the pharmacy, so you may need to add a Part D drug plan also.

Part D

Medicare Part D is simply insurance for your medication needs. You pay a monthly premium to an insurance carrier for your Part D plan. In return, you use the insurance carrier’s network of pharmacies to purchase your prescription medications. Instead of paying full price, you will pay a copay or percentage of the drug’s cost. The insurance company will pay the rest.

Your Part D insurance card will be separate from your Medigap plan.

Medicare Part D plans all follow federal guidelines. Each insurance carrier must submit its plan outline to the Centers for Medicare and Medicaid Services annually for approval.

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