This Is Not Your Mother’s Medicare

by | Jul 7, 2006 | Cash Flow, Weekly Column

By now, Medicare Part D is old news. Medicare recipients have picked their way more or less successfully through its tangled thickets and managed to enroll in one or another of its many drug plans.

That doesn’t mean, however, that you can breathe a sigh of relief and assume you’re finished with the complications of modern Medicare. Enter Medicare Advantage, formerly the plan known as Part C.

Some significant changes have been made to this plan for 2006. If you use Medicare yourself, or someone in your family does, you may already know about some of these changes. They appear to be part of a growing trend of offering more options within Medicare and doing so through private businesses.

The original Medicare program is still available, and for many people it still may be a good choice. Those enrolled in this plan usually will also need a Part D plan to pay for prescriptions and a private Medigap policy to cover copays, deductibles, and other gaps in basic Medicare coverage.

Those choosing the new Medicare Advantage instead of traditional Medicare do not need to have separate Medigap coverage. The types of Medicare Advantage Plans include:

· Health Maintenance Organization (HMO) plans. These require that you receive care from medical providers within a designated network. Most of them include drug benefits.

· Point of Service (POS) Plans. Like HMO plans, these have a network of preferred providers. They also provide reduced benefits for providers or facilities outside the HMO network and may or may not offer drug benefits.

· Regionally Expanded Preferred Provider Organization (PPO) plans. These are similar to POS plans but cover services by network providers in a larger geographic area.

· Provider-Sponsored Organization (PSO) plans. Instead of a network, these cover services provided by physicians who are part of a particular organization, such as a regional hospital.

· Medical Savings Accounts. This may be an option for some Medicare recipients.

The details of these plans are far too complicated to describe fully here. What is important is to become aware that they are available. If you or someone in your family are covered by Medicare, it would be wise to find out more about these new options. Even if you have had a traditional Medicare plan for years, that doesn’t necessarily mean it is still the best coverage for your needs.

One of the best places to find out more is through the Medicare website at medicare.gov. Another source of valuable information is the Medicare and You 2006 booklet, which current Medicare recipients should have received in the mail. If you don’t have this, you can download it from the website or call 800-633-4227 (800-MEDICARE) and ask for a copy to be mailed to you. You might also be able to get a copy at a local senior citizens’ center.

The idea of wading through pages of information to find out more about Medicare plan options is not likely to be appealing. It’s a challenge to keep up with the changes in the system. Still, making the effort can be worthwhile. The more you know, the more likely you are to be able to choose the plan that best fits your needs.

If you are currently on Medicare, keeping up to date may mean reviewing your own plan periodically, asking questions, and getting help from friends or family members if you need it. If you have parents on Medicare, you might offer to help them do some research. This will even have an extra benefit for you—just think how knowledgeable you’ll be by the time it’s your turn.

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