Medicare Providers

Medicare coverage has evolved since it was established. It was initially only administered by CMS but expanded to the private-sector with coverage now offered by insurance companies approved by Medicare. The expansion to private insurance companies provides Medicare recipient more options and possibly additional benefits to help fit their individual needs. Medicare Providers is here to help Medicare-eligible individuals understand these products and provide tools to assist in the decision making process.

Private insurance companies approved by Medicare offer two types of coverage that include:

• Medicare Supplement Insurance Plans - sometimes called "Medigap" insurance, helps pay for some of the costs Original Medicare doesn’t cover, like copayments, coinsurance and deductibles. Medicare Supplement Insurance Plans are standardized and are identified in most states by letters. What this means is a Plan G from one company has the exact same coverage as a Plan G from another company. Plan letters determine coverage such as the percentage of out-of-pocket costs that will be paid or if there will be an annual limit on out-of-pocket costs. Insurance carriers can charge different premiums for these plans, so it can be helpful to shop around. If you live in Massachusetts, Minnesota or Wisconsin, Medigap plans are standardized in a different way.
• Medicare Advantage Plans are considered Part C of Medicare and are provided by private insurance companies that contract with Medicare. Medicare Advantage plans must provide at least what Original Medicare would provide in terms of benefits. Medicare Advantage plans may have additional benefits and must include an annual out-of-pocket maximum which is not a feature of Original Medicare. Plan availability varies by service area (where you live). Medicare Advantage Plans have a monthly premium in addition to your Part B premium. Original Medicare is accepted by any doctor that accepts Medicare assignment (nationwide). Medicare Advantage plans typically have a provider network and may allow for out-of-network coverage, at a higher cost sharing amount. Medicare Advantage plans are usually Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), though there are Private Fee-for-Service (PFFS).
• Medicare Prescription Drug Plans help pay the cost of prescription drugs for Medicare beneficiaries. To qualify for a Medicare Part D Prescription Drug plan, prospective beneficiaries must already be signed up for benefits under Medicare Part A and/or Part B. Medicare Part D Prescription Drug plans are offered by Medicare-approved private insurance companies. The monthly premium of each Medicare Part D Prescription Drug plan may differ. Medicare Prescription Drug plans have a formulary which is a list of covered drugs. The formulary may change at any time. Individuals will receive notice from their plan when necessary.

In order to qualify for most Medicare-related plans, you must meet the standard Medicare eligibility requirements, and plan availability is determined by a "geographic service area."

If you move out of your geographic service area during the plan year, you can enroll in another Medicare Advantage plan approved for sale in your new location or switch to back to traditional Medicare during a Special Enrollment Period.

The number of Medicare Supplement Insurance, Part C and Part D plans available in a given area can be overwhelming. It's more than most people want to know about health insurance. The purpose of this web site is to give you the tools and information to make the right decisions for your needs.