Ah, such a simple question. Unfortunately the answer is, "It all depends." The bad news is that Medicare is anything but simple and sometimes the experts and the doctors aren't even sure what is covered. This is because Medicare coverage and plans change on a yearly basis. The good news is that in general the coverage is expanding and access to information about what is and isn't covered is becoming more readily available.
Generally speaking Medicare is divided into three different types of coverage. These are:
- Part A. Covers hospital services and inpatient care and some skilled nursing and home health care.
- Part B. Covers outpatient care including doctor's visits, preventative care and some home health care.
- Part D. Covers prescription drugs.
Now you will notice that something strange has happened to Medicare's ABC'S. Where did C go? Some incredibly bright individual decided to attach Medicare Part C to the Medicare Advantage Program. Medicare Advantage is not a type of coverage but is actually an alterative program to Original Medicare. There are many different Medicare Advantage Plans and private companies administer them all. Most of them resemble HMOs or PPOs. A more correct outline of what Medicare coverage looks like is this:
- Original Medicare Program
- Part A. Covers hospital services and inpatient care and some skilled nursing and home health care.
- Part B. Covers outpatient care including doctor's visits, preventative care and some home health care.
- Medicare Advantage Program
- Part A. Covers hospital services and inpatient care and some skilled nursing and home health care.
- Part B. Covers outpatient care including doctor's visits, preventative care and some home health care.
- Part D. Prescription drug coverage (in most cases).
Oh it would be just wonderful if it were really this simple. We could all sign up for the Advantage Program and that would be the end of it. However, Original Medicare gives you the ability to add a supplemental insurance policy to help cover the cost of prescription drugs. You also have the option of adding a Medigap policy that can help cover all the other things that are excluded from Original Medicare. The Medicare Advantage Plans are run like private HMOs and PPOs and they do include prescription drug coverage (most of the time). The problem with the Advantage Plan is that you may not add a supplemental policy to it. Your choice of providers and doctors is also limited. Furthermore, in some cases the co-pays and deductibles are higher than Original Medicare.
Deciding which plan will give YOU the best coverage is a personalized decision that is related to your health, what medications you take and what kind of care you need. Both programs can be advantageous. The trick is to learn which program and then which plan is likely to meet your needs and budget the best. Then choose that plan!
Auntie Lou says, "Good luck with that one."