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Advantage Plans

Medicare Plan Basics

Medicare Supplement Plans

Help pay for "gaps" in Original Medicare.
Include minimal standard coverages.
Offer different enhanced coverages.
Approved by each state they are offered.

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Medicare Advantage Plans (Part C)

Work like HMO or PPO health plans.
Limit out-of-pocket expenses every year.
Require you to stay in-network for services.
Sometimes include drug coverage.

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Prescription Drug Plans (Part D)

Have a Formulary or List of Covered Drugs.
Only Formulary drugs count as out-of-pocket.
Include three levels of covered expenses.
Sometimes included in Medicare Advantage.

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Medicare Providers Mission

Because of the significant amount of out-of-pocket payments required by traditional Medicare, a booming market of private-sector insurance products has grown up around the government programs. These Medicare-related insurance products are one of the fastest-growing segments of the U.S. health insurance industry overall. And they are the part of the market on which a smart consumer should focus his or her attention. Medicare Providers mission is to help seniors understand these products and provide tools assist in the decision making process.

The market for private-sector Medicare-related coverages can be described as including:
  • a group of Medicare Supplemental plans - sometimes called "Medigap" insurance, though some industry professionals don't like that term - which, to various degrees, cover the things traditional Medicare doesn't.
  • Medicare Part C plans, which replace traditional Medicare with any of several managed-care style programs that require little or no out-of-pocket payments.
  • Medicare Part D plans, which cover the cost of outpatient prescription drugs - and supplement either traditional Medicare or, in some cases, a Part C managed care plan.

In order to qualify for most Medicare-related plans, you must meet the standard Medicare eligibility requirements and live in the "geographic service area."

Medicare-related plans are regulated by each state and approved for sale within geographic service areas. In most cases, these areas are organized on a county-by-county basis; in some large urban markets, they're organized on a city or even neighborhood basis.

If you move out of your geographic service area during a plan's coverage term, you will usually have a Special Enrollment Period that allows you to enroll in another Medicare-related plan approved for sale in your new location or switch to back to traditional Medicare.

The number of Medicare Supplement, Part C and Part D plans available in a given area can be overwhelming. In some counties, there are at least 380 Supplement and Part C options available and at least 64 Part D prescription drug options - meaning you have a "menu" of over 400 plans from which to choose.

Combine those numbers with the fact that the Feds aren't keen on making consumer information available in an easy-to-use format and you have a recipe for confusion. It's more than most people want to know about health insurance. But the purpose of this web site is to give you the tools and information to make good decisions.