HMO basics

…coverage from your plan. You cannot enroll in stand-alone Part D coverage unless you join a Medical Savings Account (MSA) or Private Fee-for-Service (PFFS) plan that does not offer prescription…

PPO basics

…in-network and out-of-network care limit. Medicare PPOs are not available everywhere. Call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) to find out if there is a PPO available…

PFFS basics

…benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some PFFS plans offer additional benefits, such as vision and hearing care….

How to enroll in Medicare if you are under 65 and have a disability

…Parts A and B. If you get Social Security retirement benefits, your package and card will come from the Social Security Administration (SSA). If you get railroad disability annuity checks,…

Medicare Advantage Plan network comparison chart

…Special Needs Plans (SNPs) or Medicare Medical Savings Account (MSA) plans. A SNP is managed care plan that serves people with special needs. In an MSA plan, you can go…

Maximum out-of-pocket limit

…costs. One limit is for in-network costs and the other is for combined in-network and out-of-network costs. Call your plan directly if you have questions about your annual out-of-pocket limit….

What to look for in a doctor

…Advantage)? Is the doctor taking new patients? Is it easy to get an appointment? Is the doctor board-certified? If yes, in what field? What percent of the doctor’s patients are…

Care coordination after a hospital or skilled nursing facility (SNF) stay

…provider. You pay a 20% coinsurance after you meet your Part B deductible ($240 in 2024). If you have questions about receiving this benefit, speak to your primary care provider….

Troubleshooting when your provider refuses to file a claim

…often considered Medicare fraud and should be reported. To report fraud, contact 1-800-MEDICARE, the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 800-HHS-TIPS. If…

Appealing a higher Part B or Part D premium (IRMAA)

If your income is above a certain level, you may have to pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to your Part B premium and/or Part D premium….