X hits on this document





288 / 367



from any company at the most favorable prices available for your age group, all without having to worry about being turned down. The insurance company cannot refuse you coverage or charge you more than any other open enrollment applicants for that particular policy. Of course, the different Medigap plans will vary in premium range by what extra coverage is being offered. This also means that any health problems or preexisting conditions will not be used to with- hold any coverage from you.

Medicare Managed Health Care Plans When we discuss Medicare, we are referring to the government-run program, which is also referred to as Original Medicare. There are other options available, too. Some people have found that they can enjoy additional benefits and lower costs by joining a managed care plan. People most commonly use health maintenance organizations, or HMOs. However, there are also preferred provider plans (PPOs), private fee for services (PFFSs), and others. (See Table 13.7 for a comparison.) These Medicare managed plans must provide the med- ical and hospital services that Medicare covers.

Medicare managed plans operate in much the same way as an employer’s managed health plan would. You usually have to see a doctor within the plan’s network of physicians and receive services from within the network, as well. And, generally, neither Medicare nor the managed care plan will pay for services that are obtained from outside the network, unless it is emergency care or urgent care needed while outside the network (coverage area).

Although you may take part in the managed care plan, you must be enrolled in Medicare Part B and continue to pay the annual pre- mium. However, the plans may provide more coverage than Medicare would alone. For instance, some plans may offer coverage for hearing exams, eyeglasses, prescription drugs, and other services. You will need to refer to the plan description to determine exactly what your Medicare managed care plan offers.

Other Health Coverage and Medicare If you have private health coverage, you will need to determine how your Medicare coverage will fit in with it. Just like Medicare doesn’t

Document info
Document views520
Page views520
Page last viewedTue Oct 25 14:18:11 UTC 2016