SNP (Special Needs Plans): Are especially for people who have certain special needs. The three different SNP plans cover Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions such as diabetes, End Stage Renal Disease (ESRD), or HIV/AIDS. This type of plan always includes prescription drug coverage.
Medicare has four basic parts – A, B, C and D. If you’re unfamiliar with how they work, read Medicare 101: Do You Need All 4 Parts? Taken together, Parts A (hospital care), B (doctors, medical procedures, equipment) and D (prescription drugs) provide basic coverage for Americans 65 and older. What's relevant for this article is what these parts don't cover – deductibles, co-pays and other medical expenses that could wipe out your savings should you become seriously ill. That's where Part C comes in. Also known as Medicare Advantage, it's one of two ways to protect against the potential high cost of an accident or illness. Here's what could happen.

If you are uninsured and are not eligible for Medi-Cal or a plan through Covered California, you may qualify for limited health services offered by your county. These programs are not insurance plans and do not provide full coverage. County health programs are commonly known as “county indigent health” or programs “medically indigent adult” programs.
Medicare also has an important role driving changes in the entire health care system. Because Medicare pays for a huge share of health care in every region of the country, it has a great deal of power to set delivery and payment policies. For example, Medicare promoted the adaptation of prospective payments based on DRG's, which prevents unscrupulous providers from setting their own exorbitant prices.[77] Meanwhile, the Patient Protection and Affordable Care Act has given Medicare the mandate to promote cost-containment throughout the health care system, for example, by promoting the creation of accountable care organizations or by replacing fee-for-service payments with bundled payments.[78]
Medicare Part B premiums are commonly deducted automatically from beneficiaries' monthly Social Security checks. They can also be paid quarterly via bill sent directly to beneficiaries. This alternative is becoming more common because whereas the eligibility age for Medicare has remained at 65 per the 1965 legislation, the so-called Full Retirement Age for Social Security has been increased to 66 and will go even higher over time. Therefore, many people delay collecting Social Security and have to pay their Part B premium directly.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 renamed +Choice "Medicare Advantage".[3] Other managed Medicare plans include (non-capitated) COST plans, dual-eligible (Medicare/Medicaid) plans and PACE plans (which try to keep seniors that need custodial care in their homes). However 97% of the beneficiaries in Part C are in one of the roughly one dozen types of Medicare Advantage plans (HMO, EGWP, SNP, regional PPO, etc.), primarily in classic vanilla HMOs.[citation needed]
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Republicans believe that a Medicare program that was created for seniors and paid for by seniors their entire lives should always be protected and preserved. I am committed to resolutely defending Medicare and Social Security from the radical socialist plans of the Democrats. For the sake of our country, our prosperity, our seniors and all Americans — this is a fight we must win.
As with all HMOs—no matter whether a person is on Medicare or not—persons who enroll in a Medicare Advantage or other Part C HMO cannot use certain specialist physicians or out-of-network providers without prior authorization from the HMO, except in emergencies. In almost all Medicare Advantage plans—HMO or otherwise—the beneficiary must choose a primary care physician (PCP) to provide referrals and the beneficiary must confirm that the plan authorizes the visit to which the beneficiary was referred by the PCP. As with all HMOs, this can be a problem for people who want to use out-of -network specialists or who are hospitalized and are forced to use out-of-network doctors while hospitalized. Many Medicare Advantage PPO plans permit a subscriber to use any physician or hospital without prior authorization, but at a somewhat higher expense.
Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).
Every person is different, so you’ll want to carefully research Medicare Advantage plan options in light of your specific health needs and budget. Keep in mind that plan costs, benefits, service areas, and provider networks may all change from year to year, so it’s a good idea to review your coverage every year and make sure it’s still a good fit for your situation. Taking the time to shop around and compare Medicare Advantage plan options in your area could save you money on out-of-pocket costs.

Medi-Cal offers low-cost or free health coverage to eligible Californian residents with limited income. Covered California is the state’s health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it. Health plans available through Medi-Cal and Covered California both offer a similar set of important benefits, called essential health benefits.


It’s up to you to determine which type of coverage is the right option. It’s important to read all of the details of each Medicare Advantage plan, including the fine print, and compare the different benefits, costs, and restrictions of each plan option available in your area. If you have a specific doctor or hospital that you want to use, be sure to check that they’re included in the network of the Medicare Advantage plan that you’re interested in.
If a patient's in-network physician orders tests or procedures or refers a patient to a specialty that are not available from an in-network provider, the plan pays for the patient's procedures or services at an out-of-network location and charges in-network rates to the patient, so long as the necessary services are normally covered by the plan (the beneficiary must still obtain authorization).
If you enroll in one right out of the gate at age 65, you need to be sure you want this coverage long-term. Your open enrollment window to get a Medigap plan with no health questions ends at 6 months past your Part B effective date. You might not be able to get a Medigap plan later if you have health conditions because applying for Medigap later will require you answer medical questions. You can be turned down for Medigap at that point if you are not healthy enough to qualify.

Part A covers inpatient hospital stays where the beneficiary has been formally admitted to the hospital, including semi-private room, food, and tests. As of January 1, 2018, Medicare Part A has an inpatient hospital deductible of $1340, coinsurance per day as $335 after 61 days confinement within one "spell of illness", coinsurance for "lifetime reserve days" (essentially, days 91-150) of $670 per day, and coinsurance in an Skilled Nursing Facility (following a medically necessary hospital confinement of 3 night in row or more) for days 21-100 of $167.50 per day (up to 20 days of SNF confinement have no co-pay) These amounts increase or decrease yearly on 1st day of the year.[citation needed]
If you enroll in one right out of the gate at age 65, you need to be sure you want this coverage long-term. Your open enrollment window to get a Medigap plan with no health questions ends at 6 months past your Part B effective date. You might not be able to get a Medigap plan later if you have health conditions because applying for Medigap later will require you answer medical questions. You can be turned down for Medigap at that point if you are not healthy enough to qualify.
MA plans often include dental, vision and health-club benefits that aren’t part of many supplements. Yet people who buy a supplement have the option of buying “stand-alone” Part D prescription drug coverage from any one of several insurers — a feature touted as one of the selling points for Cost plans, too. People in MA plans, by contrast, are limited to Part D plans sold by their MA carrier, Christenson said.

Part B coverage includes out patient physician services, visiting nurse, and other services such as x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor's office. It also includes chiropractic care. Medication administration is covered under Part B if it is administered by the physician during an office visit.

If you are a Minnesota resident enrolled in Original Medicare (Part A and Part B), you have options to also enroll in a Medicare Supplement Insurance plan in Minnesota (also called Medigap or MedSupp) to cover health costs not covered under Original Medicare. Costs not covered under Original Medicare might include deductibles, copayments, coinsurance, and other out-of-pocket costs. Most states, including Minnesota, offer Medigap policies with letters corresponding with different Medicare Supplement Insurance plans with certain standardized benefits.
Medicare Part C is available through Medicare Advantage plans, and is an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans are health insurance plans offered by private health insurance companies approved by Medicare. Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.
Each Advantage plan has its own summary of benefits. This summary will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, labwork and so on. You might pay $10 to see a primary care doctor. Specialists will often be more – a $50 specialist copay is quite common. Some of the higher copays may come in for diagnostic imaging, hospital stay, and surgeries.
Part A's inpatient admitted hospital and skilled nursing coverage is largely funded by revenue from a 2.9% payroll tax levied on employers and workers (each pay 1.45%). Until December 31, 1993, the law provided a maximum amount of compensation on which the Medicare tax could be imposed annually, in the same way that the Social Security tax works in the US.[17] Beginning on January 1, 1994, the compensation limit was removed. Self-employed individuals must pay the entire 2.9% tax on self-employed net earnings (because they are both employee and employer), but they may deduct half of the tax from the income in calculating income tax.[18] Beginning in 2013, the rate of Part A tax on earned income exceeding US$200,000 for individuals (US$250,000 for married couples filing jointly) rose to 3.8%, in order to pay part of the cost of the subsidies mandated by the Affordable Care Act.[19]
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