Different Health Care Plans for Seniors With Medicare

Medicare, the federally-sponsored health insurance program primarily for seniors over age 65, consists of four main parts: Part A covers basic hospitalization; Part B covers lab costs, physicians' services and medical equipment; Part C, or Medicare Advantage, allows seniors to access benefits through a variety of managed care organizations; and Part D provides access to prescription drugs. Of these, only Part A is free; the rest require a premium. Additionally, seniors can purchase a number of standard "Medigap" policies that may help offset some expenses not covered by Medicare.

Medigap

• Medigap plans, also known as Medicare supplement insurance, help seniors cover charges not covered by Medicare. A number of these standard benefit packages are broadly the same from company to company, though the insured can choose from among a number of different plans. Other plans are available through Medicare Advantage. You do not need a Medigap plan and a Medicare Advantage plan at the same time. You must be enrolled in Medicare Part A and Part B to enroll in Part C, however.

Health Maintenance Organization Plans

• Health Maintenance Organizations (HMOs) contract with a network of area physicians, clinics, and other health-care providers to offer services for their members at discounted prices, in exchange for a steady flow of referrals. You are assigned a primary-care physician (PCP), who acts as a gatekeeper, providing you referrals to specialists within the HMO. The company typically does not cover non-emergency care outside of the network, or charges a substantial premium if you see a specialist without a PCP referral.

Private Fee-For-Service Plans

• Private fee-for-service plans allow you to go to any care provider that accepts the plan. They are less restrictive than HMOs, but typically charge a higher premium for a comparable set of benefits. There is generally no requirement to go through a primary-care physician to see a specialist.

Medical Savings Account Plans

• Medical savings account plans allow you to contribute tax-deductible dollars to an account for the purpose of offsetting your deductibles under Medicaid. Growth in these accounts is tax-deferred and withdrawals are tax-free if used for approved health-care expenses.

Special Needs Plans

• Special needs plans offer seniors with specific health needs a way to get more focused benefits that concentrate on services needed to treat specific conditions. For example, a senior with kidney problems could enroll in a Medicare Advantage plan that allows for more favorable pricing for dialysis and related services.

Prescription Drug Plans

• Seniors can get prescription drug benefits through Medicare in one of two ways: Enroll in Medicare Part D directly, or enroll in a Part C Medicare Advantage program that includes prescription drug coverage. In either case you will have to pay a premium for this coverage.