Welcome to a series we call “Medicare Myth Busters”! So much of what I hear about Medicare comes from word-of-mouth. We know from our childhood, the game “telephone” can drastically transform an original message to something completely different. Because I hear Medicare beneficiaries talk, I would like to help separate some fact from fiction on some of the most common Medicare misconceptions that I hear. We will insert the "Medicare Myth Busters" into the regular blog on occasion as we continue to advocate for our Medicare beneficiaries. The first myth buster in the series is:
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| Courtesy Pixabay |
“My Medicare Supplement Plan F is a PPO (Preferred Provider Organization) so I can go to any doctor that accepts Medicare and I don’t need referrals.”
Plan F is a Medicare Supplement or “Medigap” plan. While it is true you can go to any doctor or specialist that accepts Medicare without a referral, it is technically not a PPO. Some would say I am splitting hairs here but there are some important distinctions that make Medicare Supplement Plans and PPO’s different.
- Medicare Supplement/Medigap Plans provide standardized coverage that pays for things that Original Medicare does not cover. They are designated by a letter and companies that offer Medigap plans offer the same benefit under each letter (a table is provided below as a guide). The Original Medicare offers the primary insurance coverage and then the Medigap plan kicks in as per the letter designation to pick some of the remaining costs after the primary Medicare pays. There are no networks under this configuration and beneficiaries can expect that all coverage will be covered equally across the board in most cases.
- PPO or Preferred Provider Organizations are different in that they do have networks. Beneficiaries under these plans are covered under Part C or Medicare Advantage that are provided by private insurance companies. There are usually different benefits when using “in network” providers vs. “out of network” providers. These differences can be significant, so it is important that the beneficiary understands their benefits at enrollment.
It doesn’t surprise me that many Medicare beneficiaries do not understand these differences because some of the doctors and other providers do not know the difference either! The term PPO and Medicare Supplement or Medigap are used so interchangeably, it is no surprise there is so much confusion when it the subject comes up. Both provide increased flexibility that some people value. I highly recommend going over them with an agent to find out which plans are the right fit before you enroll.
Medicare Supplement/Medigap Description Table:
Medigap Benefits
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Medigap Plans
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|||||||||
A
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B
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C
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D
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F*
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G
|
K
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L
|
M
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N
|
|
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
|
Part B coinsurance or copayment
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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50%
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75%
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Yes
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Yes***
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Blood (first 3 pints)
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Yes
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Yes
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Yes
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Yes
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Yes
|
Yes
|
50%
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75%
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Yes
|
Yes
|
Part A hospice care coinsurance or copayment
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Yes
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Yes
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Yes
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Yes
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Yes
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Yes
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50%
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75%
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Yes
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Yes
|
Skilled nursing facility care coinsurance
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No
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No
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Yes
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Yes
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Yes
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Yes
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50%
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75%
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Yes
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Yes
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Part A deductible
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No
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Yes
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Yes
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Yes
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Yes
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Yes
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50%
|
75%
|
50%
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Yes
|
Part B deductible
|
No
|
No
|
Yes
|
No
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Yes
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No
|
No
|
No
|
No
|
No
|
Part B excess charge
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No
|
No
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No
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No
|
Yes
|
Yes
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No
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No
|
No
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No
|
Foreign travel exchange (up to plan limits)
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No
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No
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80%
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80%
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80%
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80%
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No
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No
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80%
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80%
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Out-of-pocket limit**
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N/A
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N/A
|
N/A
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N/A
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N/A
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N/A
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$5,240
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$2,620
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N/A
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N/A
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* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,240 in 2018 before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.
Source: https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
FL License: W104335 CA License: 0I77441
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