ASK THE DOCTOR - Medicare or HMO?

Question:  I am about to retire and will be eligible for Medicare insurance; but I am very confused about all the choices. Could you explain the difference between Original Medicare and Medicare Health Plans?

     

Understanding Medicare is a lot like understanding the tax code; just when you think you are beginning to understand it they change the rules again. Here is some general Medicare information provided by  Medicare :

     Original Medicare- This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.

     Medicare Health Plans (like HMOs and PPOs) - These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in Original Medicare, but it is important to check with the plan because the costs for services will vary.

     Selecting the right Medicare plan is an important decision and I suggest that you go our homepage at Ramonavna.org and click on the “Podcasts” tab and listen to an extremely informative  podcast by Ann Kasper from HICAP, the Health Insurance Counseling and Advocacy Program.  HICAP is funded through grants provided by Riverside County and their services are free of charge. They are able to  provide information and assistance with Medicare, managed care (HMOs), long-term care insurance and other related health insurance issues. Their trained volunteer counselors offer objective information to help seniors and other Medicare beneficiaries make good health care decisions. When you have insurance questions or problems, HICAP counselors can help resolve them.  If you don’t have internet access, you can contact HICAP by calling 1-800-434-0222.  

     It is important to remember that Medicare allows the patient, not the doctor or health plan, to select the Hospice of their choice. This is true regardless of whether you select traditional Medicare, or a Medicare PPO or HMO Plan.