There is a really bad piece of Medicare advertising up on the web site of the pharmacy benefit manager, which -- among many businesses -- manages Part D Medicare drug plans (so bad I am not going to link to it). There are about a dozen problems with the article from someone that supposedly is a Medicare expert. The biggest error is the statement that people on public Part C Medicare Advantage plans can not get hospice services. (I can only guess at the reason that Express Scripts would publish this bad information and it is not good. Express Scripts should be disciplined by CMS.)
The statements by Express Scripts follow in order of appearance inthe Express Scripts propaganda along with corrections IN UPPER CASE:
1. Medicare offers a variety of choices. You can choose a plan tailored to your health needs and your budget. Unless you are still working, or have retiree health and prescription drug coverage provided by your employer, you must enroll in Medicare Part A and Part B (Part A for hospital care and Part B for doctors’ visits) when you turn 65. THE PRECEDING PARAGRAPH MAKES INCORRECT LINKAGES BETWEEN WORKING AND MEDICARE DECISIONS. IT IS QUITE COMPLEX IF YOU ARE STILL WORKING AND YOU NEED TO CHECK WITH A HUMAN RESOURCES PERSON. THERE COULD ALSO BE REASONS WHY YOU WOULD NOT ENROLL IF YOU WERE NOT WORKING. SIMPLY PUT, IT'S NOT AS SIMPLE AS THE PRECEDING PARAGRAPH CLAIMS.
2. You can choose to do this through Original Medicare and then add on a prescription drug (Part D) plan and a Medigap/supplement plan as needed. Or, you can enroll in a Medicare Advantage Plan, which offers many services bundled into one plan. THE PRECEDING PARAGRAPH IS INCORRECT IN THAT IT IMPLIES THAT THERE IS A CHOICE BETWEEN ORIGINAL MEDICARE AND PART C MEDICARE ADVANTAGE. IN FACT, YOU CANNOT GET PART C MEDICARE ADVANTAGE UNLESS YOU FIRST HAVE ORIGINAL MEDICARE. PART C IS NOT AN ALTERNATIVE TO ORIGINAL MEDICARE; IT IS ADDITIVE TO ORIGINAL MEDICARE. (THE CHOICE THE AUTHOR IS PROBABLY REFERRING TO IS BETWEEN TRADITIONAL FEE FOR SERVICE MEDICARE -- TYPICALLY THE COMBINATION OF ORIGINAL MEDICARE AND A MEDIGAP SUPPLEMENT -- VS. A NETWORKED HEALTH PLAN SUPPLEMENT ON TOP OF ORIGINAL MEDICARE. THE MOST COMMON TYPE OF PUBLIC NETWORKED HEALTH PLAN OPTION IS MEDICARE ADVANTAGE.)
3, Original Medicare:
- Is operated by the federal government. THIS IS SORT OF THE MOST ACCURATE SENTENCE IN THE ENTIRE ARTICLE BUT EVEN IT IS NOT CORRECT. A PORTION OF ORIGINAL MEDICARE IS PAID FOR BY THE FEDERAL GOVERNMENT (AS IS A PORTION OR PART C AND PART D) BUT ALL OF THESE PARTS ARE "OPERATED BY" PRIVATE INSURANCE COMPANIES.
- Includes Part A (which covers hospital care) and Part B (which covers medical care, like doctor visits, lab tests and medical equipment). For details on premiums and deductibles, visit Medicare.gov. REMEMBER, AS STATED ABOVE, YOU HAVE TO FIRST ENROLL IN OR BE ENROLLED IN ORIGINAL MEDICARE BEFORE YOU CAN SIGN UP FOR PART C OF MEDICARE (OR A PRIVATE MEDIGAP SUPPLEMENT)
- Does not cover prescription medications, ORIGINAL MEDICARE DOES NOT COVER MOST SELF-ADMINISTERED PRESCRIPTIONS. IT DOES COVER PRESCRIPTIONS WHERE THE DRUG IS ADMINISTERED BY A HEALTHCARE PROVIDER
4. Medicare Advantage Plans:
- Also known as Medicare Part C or Medicare Health Plans, MEDICARE ADVANTAGE IS JUST ONE TYPE OF PART C PLAN
- Provide Part A and Part B — and oftentimes, Part D — all in one plan. THAT IS A SIMPLISTIC WAY OF LOOKING AT THE PUBLIC PART C MEDICARE ADVANTAGE PROGRAM BUT -- MOST IMPORTANT -- PART C HAS AN ANNUAL OUT OF POCKET SPENDING LIMIT WHEREAS PARTS A AND B DO NOT. THEREFORE, EFFECTIVELY IT PROVIDES MUCH MORE THAN PARTS A AND B.
- Private companies that are approved by Medicare operate these plans. "PRIVATE COMPANIES APPROVED BY MEDICARE OPERATE" ALL PARTS OF MEDICARE -- A, B AND D -- NOT JUST MEDICARE PART C PLANS
- You can choose from a variety of plans that are like the choices you may have had through your employer-provided health benefits. THE VARIETY OF CHOICES DEPENDS ON WHERE YOU LIVE
- Each option will have a monthly premium. SOME MEDICARE ADVANTAGE PLANS HAVE NO MONTHLY PREMIUM
- Depending on the plan, there may also be a deductible, and a copayment/coinsurance at the time of service. THESE COPAYS AND DEDUCTIBLES ARE ALMOST ALWAYS SUBSTANTIALLY LESS THAN THE DEDUCTIBLES AND COPAYS THAT COME WITH ORIGINAL MEDICARE.
- Unlike Original Medicare, Medicare Advantage plans do not cover hospice care. PEOPLE ON MEDICARE ADVANTAGE ARE ELIGIBLE FOR HOSPICE CARE. (THE AUTHOR IS APPARENTLY CONFUSING THE PAYMENT STRUCTURE FOR HOSPICE UNDER THE PART C PROGRAM WITH ITS AVAILABILITY.)
5. Medigap/Medicare Supplemental Plans:
- Plans are offered by Medicare-approved private insurance companies that cover costs not paid by Original Medicare (such as deductibles, coinsurance and copayments). There are 10 supplemental plans that offer a variety of supplemental options and are labeled A, B, C, D, F, G, K, L, M, and N. THIS IS NOT TRUE IN ALL STATES
- Some Medigap plans also offer coverage for services that Original Medicare does not cover, such as, medical care when you travel outside the U.S. They do not cover long-term care, vision, dental, hearing, or private nursing. SOME DO. IT IS STATE-REGULATED PRIVATE INSURANCE. IT CAN COVER ANYTHING IT WANTS TO COVER BUT WITH SOME OVERSIGHT BY THE MEDICARE BUREAUCRACY.
- You may already have employer or union coverage that covers costs Original Medicare does not. Retired military service members receive supplemental coverage through TRICARE. Be sure to look at TRICARE, or other supplemental coverage before selecting a Medigap policy.
6. Which route is right for you?
- Consider Original Medicare and a stand-alone Part D plan if:
- You wish to have greater choice and access to a larger network of health providers and facilities (most do accept Medicare)
- You would like to have greater choice in selecting a Part D plan that better suits your prescription medication needs
- You have supplemental coverage from an employer to cover some of the costs and services Medicare does not
- You require hospice care PEOPLE ON MEDICARE ADVANTAGE CAN RECEIVE HOSPICE CARE
- You do not mind coordinating coverage from multiple providers
- PARTICULARLY CHOOSE A FEE FOR SERVICE APPROACH IF YOUR PROVIDER IS NOT PART OF A NETWORK. ALSO MOST NETWORKS ARE GEOGRAPHIC SO THE FEE FOR SERVICE APPROACH IS BEST FOR PEOPLE THAT LIVE IN TWO DIFFERENT PARTS OF THE U.S. DURING THE YEAR
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Consider a Medicare Advantage plan if you:
- Like the convenience of having all of your coverage through one provider IT'S ONE INSURER, NOT ONE PROVIDER
- Prefer a plan that is similar to what you may have had through an employer
- Want the ability to purchase a plan that covers services not available through Medicare, such as vision, dental, and hearing
- Are willing to use in-network doctors and medical facilities like in an HMO or PPO
- Find a Medicare Advantage plan that offers Part D coverage that fits your needs. You can purchase a stand-alone Medicare Part D plan if you choose a Medicare Advantage plan that does not offer Part D coverage.
- Consider a Medigap/Medicare Supplement Plan if you:
- Expect to have high-cost medical needs, such as surgery or hospitalizations. All Medigap plans will cover 100% of your Part A coinsurance and hospital costs that are not covered under Original Medicare.
- Need assistance with your Part B copayments or deductible because you see the doctor frequently, or use medical equipment or devices.
- Do not have supplemental coverage provided by an employer or the military.
- Travel frequently outside the U.S. TYPICALLY MEDICARE ADVANTAGE PLANS COVER EMERGENCY COVERAGE OUTSIDE THE U.S. TO THE SAME EXTENT THAT MEDIGAP POLICIES DO
- Require hospice or skilled nursing facility care, as many Medigap plans offer 50% to 100% coverage of your costs after Medicare pays its share. MEDICARE ADVANTAGE COVERS HOSPICE AND SKILLED NURSING; THE AUTHOR OF THIS ARTICLE IS SIMPLY INCORRECT IN HIS UNDERSTANDING OF MEDICARE ADVANTAGE
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