Top Carriers Dropping Medicare Advantage Private Fee-for-Service Plans

Top health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that is available through a state licensed, risk-bearing entity, or a PFFS Medicare Advantage Organization (MAO).

As a result of PFFS coverage drops by Coventry and WellCare alone, more than 500,000 Medicare beneficiaries will have to find new coverage.

Currently, Medicare Advantage plans receive government subsidies so that they can offer beneficiaries more benefits than simple Medicare plans. Medicare Advantage plans are offered to Medicare-eligible individuals by private health insurers. However, analysts are expecting the reimbursement rates for these PFFS programs to fall by approximately five percent, making them less profitable for insurance carriers.

How PFFS Currently Work

PFFS are popular amongst consumers because they allow Medicare beneficiaries to choose their own healthcare providers, rather than having to select their providers from a limited number of in-network of Medicare-approved providers. Beneficiaries can see any provider, as long as the provider agrees to charge based on the PFFS fee schedule. This fee schedule is the same as the Medicare schedule.

PFFS MAOs have yearly contracts with the Centers for Medicare and Medicaid Services to provide Medicare beneficiaries with their Medicare benefits as well as additional benefits that a company opts to provide. Essentially, the PFFS provider pays for healthcare instead of Medicare when a beneficiary has such a plan.

The main benefit (which makes PFFS so popular) is that individuals who join PFFS MAOs are not required to use providers within a network and can, therefore, see any provider as long as the provider is able to receive payment from Medicare and the PFFS MAO.

More Changes to PFFS Plans

In addition to the decreased government reimbursement amount for PFFS plans, PFFS plans will be required to develop healthcare provider networks beginning in 2011. The change will force PFFS beneficiaries to select their healthcare providers from within the plan network, limiting their freedom to see providers that they prefer.

Experts predict that more healthcare insurance providers will follow Coventry and WellCare by dropping their PFFS plans in coming months. Individuals should contact their healthcare insurance providers if they are currently enrolled in a PFFS or are considering enrolling in a PFFS to get more information about how their provider will respond to the upcoming PFFS changes.

More Information About Medicare Advantage Plans

Medicare Advantage plans are specific types of Medicare plans that are in place to cover the cost of healthcare related expenses for Medicare participants. These plans are similar to traditional Medicare plans in that they provide financial support for individuals seeking medical or health-related services. However, the Advantage plans generally have more benefits and lower copayments than many other types of Medicare plans. In order to have a Advantage plan, Medicare participants need to have Medicare Part A and Medicare Part B plans.

One major difference between Medicare Advantage plans and other types of Medicare plans is that Medicare Advantage participants may need to see only doctors that are members of the Medicare Advantage provider plan. However, plans may allow participants to use a wide variety of services, including Medicare Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service providers, and Medicare Special Needs providers.

Medicare participants should also be aware that Medigap policies do not provide gap coverage for individuals that participate in the Medicare Advantage program.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medigap coverage. Our professional medigap advisors will help you choose the best plan.

What Medicare Does and Does Not Pay in 2010

A summary of seniors medicare benefits for 2010:

Considering the fact that most seniors live on a very tight budget, what medicare will and will not pay for medical cost is a major concern for most seniors. Unfortunately, the government is on a yearly basis increasing the medicare premiums and reducing the benefits medicare will pay. This brief article will outline in general the present state of medicare and what medicare will and will not pay in 2010. The article will also discuss briefly the various alternatives available to seniors to fill in the gaps on what medicare does not pay and expects the senior to pay out of pocket.

Medicare Abc's: 2010

Medicare has four areas of coverage: ABCD

Medicare Part A: Hospital Expenses.. If a senior is in the hospital for 24 hours medicare will pay for all hospital cost for the first 60 days after a $1100 deductible. ( note, this deductible is reinstated every 60 days for subsequent admissions or possibly six times a year).

61-90 days- The senior has to pay $275 per day

91-150 days- The senior pays $550 per day

After 150 days- The senior pays 100%

Medicare Part B: Doctor's cost( visits-surgery), including lab test, xrays,etc.

If already enrolled in Part B, the monthly cost for Part B is $96.40, usually deducted from your social security check. If a new enrollee in 2010 the cost is $110 per month..And increases if your income exceeds $82,000

Under part B medicare will pay only 80% of the cost and the senior pays the additional 20%.

Part C: Under Part C the senior can enroll with one of many carriers that will help fill in the gaps where medicare does not pay. It is called Medicare C Advantage Plan. The premiums are relatively low or nothing. However, under a Med C you can expect deductibles, co-pays, waiting periods,etc. Also Med C plans are run like group health plans where the carrier dictates the doctors, the place, the time etc of your medical care much like PPO's and HMO'S.

Part D: Prescription coverage. Briefly, the premium for Part D coverage is relatively inexpensive. However, unless you are taking some very expensive drugs, many national drugs stores offer very inexpensive drug programs to seniors.

Supplemental Coverage: A number of private carriers offer Medicare supplemental coverage. Supplemental meaning coverage that fills in the gaps that Medicare does not pay under Part A and Part B above. In others words, supplemental payments for the co-pays and deductibles previously discussed regarding Part A and Part B that the senior has to pay out of pocket.

Supplemental Coverage VS Part C coverage. As previously stated, Part C coverage by a private carrier is administered much like group health with co-pays, deductibles and a selection of their doctors. Supplemental plans vary in coverage and the yearly supplement premium is based on the degree of coverage.Ther are supplemental plans that pay all of the cost medicare does not pay under Part A and B to plans that may have a $2000 yearly deductible. The advantage of the supplemental plans is that you have control over which doctors you go to,anytime and anywhere. Of course the less you have to pay for coverage of the un-paid medicare cost the more your supplemental premiums will cost. Keep in mind that regardless of the cost for supplemental coverage, the premiums are far less than traditional non-medicare major medical coverage, and with better benefits.

Also, regardless of your pre-existing medical conditions most people have the opportunity to qualify for medicare supplements, so if you are turning 65 be sure to discuss the various supplemental medicare plans available and enroll when the pre-existing conditions are not a factor.

Obviously, this has been a very general overview of Medicare 2010, but hopefully outlines the medicare coverage and supplemental coverages available. And keep in mind that medical coverage is so critical to any senior that it is imperative to consult with an insurance professional in your state to know what alternatives are best for you.

If you have any questions about this issue please contact me at my website and I will direct you to an insurance professional in your area. Hopefuly this brief summary has been helpful and beneficial.

David Burlison, JD and licensed insurance producer in the state of Tennessee
http://www.travelaskthelocals.yolasite.com

Travelaskthelocals is a unique website where locals at your destination answer pertinent questions about your travel plans and offers excellent travel links to plan any travel adventure. Just go to this web site.

http://www.travelaskthelocals.yolasite.com

Coverage Options For Medicare Eligible Individuals

People with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans consist of HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO's (Health Maintenance Organizations) which have been available since the 1980's.

To help your parents (or you) make an informed decision, they need to understand how these plans work, and then decide which plan is right for them. The following is a brief description of each of the plan types.

Original Medicare

If an individual elects to go with traditional fee for service Medicare, they can generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare does have deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.

Medicare Advantage Plans (Part C)

If you opt to go with a Medicare Advantage Plan, you actually trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are offered to eligible individuals at little or no cost other than continued payment of their Part B monthly premiums.

Medicare HMO's (Health Maintenance Organizations)

These plans cover the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO's are attractive to Medicare eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by traditional Medicare.

Individuals considering a Medicare HMO should be aware that they can only receive medical services from providers who are part of the HMO's network of contracted providers. The HMO usually requires that an individual joining their plan select a primary care physician from those who participate in their network. This primary care physician would then be responsible for all medical care including referrals to a specialist and admittance to a hospital. The HMO will not pay for unauthorized visits to specialists nor non-emergency care received outside the HMO's service area or visits to non-network physicians.

Medicare PPO's (Preferred Provider Organizations)

These plans are private healthcare plans like HMO's. However, PPO's and HMO's do differ into two very important areas. First, Medicare PPO's do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, second, Medicare PPO's do not usually require that you obtain an authorization before seeking care from a specialist.

Regional PPO's are available in many areas of the country. These plans serve large geographic areas and must offer the same premium costs and plan benefits to all individuals residing in these areas. Medicare PPO's cover the same types of medical expenses that traditional Medicare does. In addition, Medicare PPO's commonly include a prescription drug benefit. Unlike traditional Medicare, Medicare PPO's have an annual out of pocket limit for benefits covered under Parts A and B of Medicare. The out of pocket limit caps the amount an individual can spend on covered medical expenses in a calendar year. As with any PPO program, when an individual uses a non-contracted provider for covered services, they will pay more out of their pocket.

Private Fee for Service (PFFS) plans

These plans are available to Medicare beneficiaries in exchange for their traditional Medicare Benefits. PFFS don't have a formal network of doctors and hospitals to choose from and not all doctors or hospitals are willing to provide medical services to participants in these types of plans. If an individual is considering enrollment, it is wise to check with their doctor and local hospitals to make sure that they will accept the plan's payment for services before enrolling. Also, the enrollee should thoroughly understand the benefits of a fee for service plan because the fee for service plans decide how much they will pay for Medicare covered services and may charge a higher cost sharing percentage than traditional Medicare. Private fee for service plans may include a prescription drug benefit. If they do not, the enrollee is free to join a Medicare stand alone prescription drug plan.

Special Needs Plans (SNP)

These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help paying for their medical benefits. These would include individuals who qualify for both Medicare and Medicaid (MediCal in California), those residing in long term care facilities, and those with chronic or disabling medical conditions.

Medicare Prescription Drug Plans (Part D)

Prescription drug plans are available to all Medicare eligible persons regardless of medical history or income levels. When a person first qualifies for Medicare, their initial enrollment period begins three months before their 65th birthday, includes their birth month, and ends three months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on the following January 1st.

Medicare drug plans are designed to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there is a monthly cost for these plans. In addition to a monthly premium, the covered individual is required to pay a percentage of the cost of the medications (or a copay) and Medicare pays part of the cost. Costs for a plan will vary depending on the medications taken and the type of plan selected. At a minimum, the plans available must provide a "standard" level of coverage.

For 2010, a standard prescription drug plan will have the following costs:

A monthly premium which varies from approximately $24 per month to in excess of $100 depending upon the plan selected and medications taken.

An annual deductible equal to the first $310 worth of prescription drugs.

After the annual deductible has been satisfied, the insured will pay the following amounts for the remainder of 2010:

25% of the cost for covered medications from $310 up to $2830 in charges, (the plan pays the other 75% of these costs); then

100% of the next $3842.50 in total drug charges (often called the donut hole or coverage gap); then

After exceeding the annual of pocket limit of $4550, 5% of your drug costs or a copay of $2.50 or $6.30, whichever is greater for the rest of the current calendar year.

This describes a "Standard Plan." Many of the prescription drug vendors do offer better benefit plans which forego the plan deductible and substitute copays instead of the 25% coinsurance. Generic medications are available for substantially less than brand names with these plans.

There is a penalty of 1% per month, using the average national premium, for non-enrollment/late enrollment, which is assessed for as long as they remain enrolled in the plan.

This has been just a brief overview of the benefits available to Medicare eligible individuals. For more detailed information, please consult the Medicare handbook, Medicare & You. The handbook is available by contacting Medicare at 1-800-MEDICARE or visiting the Medicare website at http://www.medicare.gov.

In addition, a copy is available at our website- http://www.waldenbrokers.com. Should you or your parents need assistance in selecting a Medicare plan, please feel free to contact us at 818-597-2890.

Edward Walden, CLU, RHU, REBC

New Medicare Reporting Requirements and How it Affects Plaintiffs Attorneys

New Medicare Law and how it affects the Plaintiffs Bar

If you primarily practice personal injury law then you need to be aware of the new Medicare reporting law otherwise you and your client will not see the money from your recent settlements.

The Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) has now gone into effect as of January 1, 2010 and has brought with it new issues for Plaintiffs and their attorneys. It is important to be aware of these changes as they can now seriously delay your settlements.

The amendments, codified at 42 U.S.C. ? 1395 y(b)(8), now require liability insurers (which are defined to include self-insured entities) to report payments related to bodily injuries incurred by Medicare beneficiaries. It also requires that the Medicare beneficiary or "other party," defined by the regulations as including the entity making the payment, must reimburse Medicare within 60 days of the payment or be subjected to a $1,000 a day fine along with interest. The regulations further provide that if Medicare is not reimbursed within 60 days the primary payer must reimburse Medicare even though it has already reimbursed the beneficiary or other party.

This means that an insurance company settling a claim may be liable for paying the Medicare lien, even after paying the plaintiff, if the Plaintiff does not reimburse Medicare within 60 days of the date of payment. So now more than ever insurance company adjusters and their attorneys are making sure that Plaintiff's attorneys are resolving Medicare liens before they will issue payment of any settlement check.

If you have dealt with Medicare in the past you know the problems inherent in notifying them of your claim and trying to resolve your client's lien. If you have not dealt with Medicare before you need to seriously consider co-counseling with an attorney experienced in the area.

Whenever Medicare provides a lien they simply provide a search from the date of the accident through the date of the request. This means that the lien will include charges that are not related to your client's accident that you will have to dispute. Unfortunately, Medicare will not provide your final lien amount until 10 days after they are notified that the case has settled. Further problems arise because it takes Medicare in excess of 45 days to evaluate and remove unrelated charges from their lien so even if a plaintiff's attorney puts Medicare on notice at the inception of a claim and provides the information necessary for Medicare's contractors to evaluate the claim, the contractor will not issue a final demand letter setting forth Medicare's entitlement until notified of the settlement. This means that your client's lien amount can change at any time and you will have to pay Medicare whatever they are claiming or your client will be responsible for late fees and fines. Medicare's position is that it should receive its full demand entitlement pending resolution of such issues.

This is now causing insurance companies to be directly involved in the Plaintiff's negotiations with Medicare. Insurance companies and their attorneys will now want to include Medicare on any settlement checks as an essential element of any proposed settlement despite the fact that there is nothing in the current statute or implementing regulations requiring that payment be directed to Medicare or CMS.

So how do we avoid this?

Make sure to put Medicare on notice at the inception of a claim and negotiate their lien before settling your case. This is the only way to avoid significant delays at the end of the case when the Plaintiff is waiting on their money. If you do not know how to handle a Medicare lien then be sure to review my pamphlet "How to handle a Medicare lien" available on my website.

Then try to have the insurance company agree to a hold harmless and release providing indemnification from any claims by Medicare including fines and/or interest.

If they will not agree then as a last resort negotiate with the adjuster or attorney to enter into an enforceable Settlement Agreement, which would be reported to Medicare, but deferring the actual payment of the settlement funds until such time as you have obtained a final demand letter from Medicare setting forth Medicare's entitlement. Separate checks can then be issued to Medicare on the one hand, and the plaintiff and plaintiff's attorney on the other.

Christopher Wigand is a trial attorney and partner with Winston & Clark, P.A. in Plantation, Florida. The majority of his practice involves handling cases for other attorneys who do not litigate. Mr. Wigand has devoted his career to helping injured individuals and families. He is always available to discuss a co-counsel arrangement or for direct client referrals. For more information on contacting Mr. Wigand please see his website at http://www.christopherwigandlaw.com.

Medicare Supplements and Medicare Advantage Plans Are Not the Same Thing

Medicare Advantage Plans, are health plans from insurance companies that have a contract with CMS (Center for Medicare and Medicaid). Individuals who have Medicare Part A and B are eligible to choose a Medicare Advantage plan. Specialized plans exist for people with certain health conditions, but beyond that the general plans are not allowed to decline based on health except for very specific reasons.

When an individual is enrolled in the plan they do not lose their Medicare. They are entitled to cancel their Medicare Advantage plan, and the next month, they can go back to original Medicare. While enrolled in Medicare Advantage, they will have to use the insurance card provided by the Medicare Advantage plan instead of their Medicare card.

These plans may cost the participants nothing, or very little, though many still require the Part B participation amount. A Medicare Advantage plan is not free however. The plans receive a contribution from CMS every month, instead of having that tax money go to original Medicare. That is how the bulk of the plan is paid for, from tax money.

Traditionally, Medicare Advantage Plans were thought of as HMO plans were an insured person had to use the plan hospitals, doctors, and other medical providers to be covered. Many Medicare Advantage Plans are HMO plans. However, PPO Medicare Advantage plans also exist. Fee for Service Medicare Advantage Plans, or plans that will cover any medical providers who accept the insurance, are being marketed aggressively these days.

Your own medical needs and preferences will determine which plan will work out well for you. If your current medical providers contract with the plan's HMO, then you may be very satisfied with comprehensive coverage with very little extra payments. If you like more choice, and area doctors will accept a Free For Service plan then you might consider an "Any Doctor" plan. Be aware that not all doctors work with the Fee For Service plans, even though the insurance company claims it will work with any doctor! A great compromise is provided by PPO plans. You get the greatest coverage at the lowest price inside the network, but will still be covered by other medical providers.

Most, but not all, Medicare Advantage plans also contain Part D, or prescription drug coverage. Medicare Advantage plans may have very low, or no, premium for the insured people beyond their normal Part B premium. Some plans even refund the Part B premium. Also, Medicare Advantage Plans are not allowed to do a lot of risk selection based upon health, so they may be a good choice for less healthy applicants.

A traditional Medicare Supplement is very different from Medicare Advantage. With Medicare Supplements you still use your original Medicare Card, and add your Medicare Supplement health card. These plans are also provided by insurance companies, but they simply supplement the coverage gaps and deductibles not provided by original Medicare Part A and Part B.

If you have Medicare Part A and Part B, your Medicare supplement plan will pay the portion of your medical bill that Medicare will not pay. Of course, Medicare supplement plans differ, and so you need to be aware of exactly which portions a Medicare Supplement plan will pay before you sign up. For instance, Medicare may be 80% of your hospital bill, and your supplement will pick up the other 20%.

Medicare supplements come with premiums, and also may exclude unhealthy individuals. However, they generally provide the broadest access to health care.

Choosing a Medicare health plan can be one of the most important decisions a Medicare beneficiary will make. Let us help you find the right plan to fit your needs, lifestyle, and budget.

Compare Supplemental Medicare Health plans with simple online zip code searches

Medicare Part What?

Are you confused by Medicare? If you are, you are not alone. When you first begin to learn about Medicare, you are confronted with a whole new set of information. There is Medicare Part A, Part B, Part C, Part D.

If that were not confusing enough, you can add Medicare Supplement insurance to your new knowledge base, and you have a whole new set of Parts (or at least plans). Medigap Plan A, Plan B, Plan C, all the way through Plan L. Now, in 2010, that whole structure is changing yet again.

An then, to add insult to injury, even if you learned how to decipher all of these Medicare Part something or others, you still need to have a basic knowledge of health insurance terms. Deductibles, co-insurnace, co-pays, etc. ad nauseam.

The truth is, if you are like most people newly qualifying for Medicare, you don't care about becoming an expert in Medicare, but you would like to know at least a little about the system that will cover you, perhaps for the rest of your life.

Following is a very simple primer, in which I give you everything you need to know and probably care to know.

Medicare Part A

Part A is the Medicare Part that pays for in-patient hospital expenses. The way I like to remember it is that it pays your expenses (A)fter you get (A)dmitted.

Medicare Part B

Part B is the Part of Medicare that pays for most out-patient expenses like visits to your doctor. The way I like to remember it is that it pays for your expenses (B)efore you get admitted to a hospital.

Medicare Part C

Part C is that Part of Medicare that insurance companies to manage your health care (instead of Original Medicare). You probably know someone who accesses their Medicare benefits via an HMO, or network. That person is most likely participating in a Medicare Advantage Plan (which is another word for Part C).

Medicare Part D

Part D is the Part of Medicare that provides insurance plans for your prescription medicines. This one is easy to remember also. Part D stands for (D)rugs.

I should note that you can't access Parts C & D directly from Medicare. As of this writing, you have to participate in these parts through a privately contracted insurance company.

For example, both Company ABC and Company XYZ offer Medicare Advantage Plans (Part C). You have to enroll with those companies to participate. Every company that offers these plans, is highly regulated and works closely with Medicare.

The same goes for Part D. Both Company ABC and Company XYZ offer Prescription Drug Plans. You have to get your drug coverage through a company that sells one of the plans.

Speaking of plans, what about all of those Medigap Plans? A,B,C,D,E, Etc.?

A Medicare Supplement Plan is also known as a Medigap Plan, because it "fills in the gaps" left by Original Medicare. Remember all of those insurance terms? Deductibles, Co-insurance, etc. These plans (also available only through private insurance companies) pay for some or all of your share of the cost. The plan letter, like "A" or "F" simply have to do with the level of coverage you desire.

So that is all for this primer. I have a 4 year old, and if he walks in any time soon, I am sure I will be tempted to sing that tune... "Now I said my ABC's, won't you sing along with me?"

Get help now with the Medicare Part that is confusing to you. Go now to: MedicareNational.com

At MedicareNational.com, our goal is to help you feel secure, save money and get the plan that is right for you. We Make Medicare... Easy!

A Guide to Medicare Coverage

Signed into law by then-President Lyndon B. Johnson on July 30, 1965, Medicare coverage began as a social insurance program for American citizens age 65 or older. Today Medicare also covers citizens who may not be 65 years old but demonstrate need. Those suffering with Lou Gehrig's Disease, in need of a kidney transplant or have been receiving Social Security benefits for at least 24 months are all examples of people who qualify for Medicare.

Originally, Medicare coverage applied only to Hospital Insurance (known as Part A) and Medical Insurance (Part B). Former President Harry S. Truman was the first recipient of an official Medicare card, which then rarely entitled the holder to prescription drug coverage. As of early 2006, more comprehensive drug coverage was provided.

Medicare Part A

Part A of Medicare is Hospital Insurance, which will cover hospital stays, nursing home or assisted-living home care for a period of time. To receive the benefits of Medicare Part A, there are four main criteria that must be met, the first of which addresses only hospital visits:

The hospital stay must be a minimum of three days and three midnights, not including the day you are discharged
A nursing-home stay is covered only if the problem is diagnosed during the hospital visit outlined above. For example, if a respiratory issue sent you to the hospital, Medicare would cover a nursing home stay to help rehabilitate your lungs.
If you don't need rehabilitation at a nursing home but have an ailment that requires constant medical assistance or supervision, the stay would be covered.
Those caring for you at the nursing home have to be skilled. Part A of Medicare does not cover long-term, unskilled or custodial care.
Regarding nursing-home stays, Medicare will only cover 100 days per ailment. The first 20 days are paid for by Medicare in full; the next 80 days require a copayment of $128 per day (as of 2008). Whenever you go 60 days without using Medicare to help pay for a nursing home stay, the 100-day clock is reset and you qualify for a new 100 day period.

Medicare Part B

Part B of Medicare deals with Medical Insurance. This section covers most outpatient services and medically necessary products that Part A leaves untouched. Everything from doctor's visits to immnuosuppressive drugs for organ-transplant recipients are covered by Part B, including limited ambulance transportation.

In addition to outpatient doctor's services and treatments like chemotherapy, Part B helps you to pay for durable medical equipment (DME). Examples of DME include mobility scooters, prosthetic limbs, canes and oxygen.

Medicare Part C

Part C of Medicare deals with Medicare Advantage plans. After the Balanced Budget Act of 1997 passed, Medicare recipients were given the choice to either keep their original Medicare plan (Parts A and B) or receive their benefits through a private health insurance plan. After the Medicare Prescription Drug, Improvement and Modernization Act was enacted in 2003, those using private health insurance through Part C became known as Medicare Advantage (MA) recipients.

If you choose Medicare Advantage, Medicare will pay a set amount each month toward private health insurance. You're required to pay any additional premiums, and in many cases you'll have to pay a fixed copayment amount (usually around $10 or $20) each time you see a doctor. By law, the private insurance company you choose must offer a benefit package that is at least as good as the one provided by Medicare Parts A and B.

Medicare Part D

Medicare Part D provides coverage for prescription drug plans and went into effect at the beginning of 2006. If you use Medicare Part A or B, you are eligible for Part D. If you're using an MA Plan, you can adjust your benefits to take advantage of Part D, in which case the overall plan becomes an MA-PD.

To get Medicare Part D, you need to enroll in a Prescription Drug Plan (PDP) or change your MA coverage to MA-PD. Costs and benefits vary between the different plans, and medications that you need may not be covered by all plans. Some drugs, such as cough suppressants, benzodiazepines and barbiturates, aren't covered at all.

To get the best Medicare Part D coverage at the best price, you should compile a list of your prescriptions and talk to your pharmacist, MA provider or a Medicare representative. You can get a head start by visiting http://formularyfinder.medicare.gov/formularyfinder/selectstate.asp, which provides a list of Medicare Part D options by state when you provide your prescriptions.

Costs

Each year that you work, 2.9% of your wages are taxed under the Federal Insurance Contributions Act (FICA) and applied to your future Medicaid coverage. This 2.9% is split between employers and employees. Those who are self-employed have to pay the full 2.9% on their own. There is no limit to the amount of your wages that must be paid to FICA tax.

Once you're eligible for Medicare, it works like private health insurance. Your care provider bills Medicare for expenses, and you make up any differences that aren't covered.

Medicare coverage is limited, and while it can provide some protection for routine expenses or a minor injury, such as a broken leg, it's not a solution for long-term care needs. For this reason, it's a good idea to look into supplemental coverage, known as Medigap, to cover additional costs. While the monthly premiums for Medigap insurance can be high, they're still far lower than the medical bills that pile up in the event of a catastrophic illness or if you need long-term care.

For more information on medicare, visit the career and money section of Life123.com.