Medicare is one of the most complicated types of senior health insurance on the market. If you qualify for Medicare you must choose your level of coverage and for some levels a health insurance company. Understanding what you need will help you find the best health insurance company for you.
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Medicare is broke down into five parts for available coverage; parts A, B, C, D and Medigap. Part C is also called Medicare Advantage and Part D is prescription drug coverage. Part A and B are provided directly from the government based on what you qualify for. You do not need to shop private companies for coverage.
Part C allows you to choose a health plan approved by Medicare through a private company. They will pay you a certain amount each month towards your premiums. These plans will offer the same coverage as Part A and B as well as additional services. It may include things such as dental, vision, or prescription.
Part D allows you the option to purchase health insurance prescription coverage. You can purchase a plan as a supplement to Parts A and B or as part of Part C plan. These plans help cover some of the cost of most prescription drugs. Each plan has its own list of covered medications.
Medigap insurance is the most difficult to understand. There are twelve different types of policies you can purchase; their purpose is to help cover expenses from Parts A and B. If you chose a Part C plan Medigap will not pay out, so you must carefully evaluate which option works best for you.
The Best Part C Medicare Plans
Part C plans come from private health insurance companies. This means you can find plans that are fee for service based or managed care such as HMOs and PPOs.
There are several factors to consider when purchasing a plan. You need to look at the price and coverage offered. You also need to consider how much Medicare is paying towards your premiums and how much out of pocket expenses you will have.
In 2010 the Kaiser Family Foundation devised a rating system for Medicare Advantage policies on the market that year. They used a five star system based on the following four factors:
- CMS administrative data on quality and satisfaction
- The Consumer Assessment of Healthcare Providers and Systems
- The Health Outcomes Survey
- The Healthcare Effectiveness Data and Information Set
Based on their system, the highest rated HMO plan was Kaiser Permanente with 4.07 stars. It was closely followed by Highmark which had 4 stars and third on the list was Emblem Health with 3.30. The number one slot for PPO plans that year was actually held by two companies; Health Net and Highmark both received 3.5 stars. Aetna was not far behind them on the list with a 3.35.
Fee for services plans had fewer companies to make the list due to lack of statistics. There was a clear leader in the group though. Highmark was ranked with 4 stars and the second place position went to Humana with 2.51 stars.
Best Part D Medicare Supplement Plans
Since many Medicare Advantage plans include prescription drug coverage this section will only look at supplemental health insurance coverage for Medicare. These are plans you can purchase if you choose to use Part A and B Medicare coverage. The problem with rating prescription drug coverage is the variables are too numerous. While people can expect they will need a certain level of medical care they medications people take to treat the same disease can vary greatly.
There is help available! Medicare has set up a tool to assist you in finding a plan on their website. You simply enter information about what coverage you are using as well as all medications you take. You even get to choose which local pharmacy you want use and it shows you plans available to you and the costs.
Another good resource is your state’s health insurance assistance program. They use federal grants to provide each state with one-on-one counseling services. These counselors are there to help you and your family members understand your available Medicare options.
Best Medigap Insurance Plans
Medigap insurance is another complicated issue. There are 12 different types of Medigap plans. Not all of these plans are offered in every state though. Choosing the right plan will depend on your needs.
Medigap is not the same as Medicare Advantage. It is designed to fill in the gaps of your Part A and B coverage where as Medicare Advantage is a comprehensive policy that replaces Part A and B. When choosing a Medigap plan you need to look at your policy to see where those gaps are.
The Medicare website offers an interactive tool for finding Medigap insurance. It allows you to compare the types of insurance policies available to you then look at companies who offer the type you choose.
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