-----There's a window of opportunity, at the end of each year, to change a Medicare policy. Otherwise the elder is left with whatever policy is in place when that window, for change, closes. While that re-enrollment period is still open, there are different types of Medicare policies to choose from.
-----"Traditional" Medicare For Elders who choose Part-B standard policies: The fee amounts to $105 deducted monthly from their social security check. The traditional policies approve a certain dollar amount per procedure, which is sometimes considerably less than the medical provider is billing. One such medical procedure, for example -- an MRI -- may be billed at $1,000, but Medicare approves $200 and of that, the Part-B policy-holder must pay 20%, or $40. So, for standard Medicare, there is a 20% out-of-pocket expense on Medicare-approved fees. To pay this fee, there are Medicare-supplemental policies sold by many insurance companies. The policy would then cover the 20% that traditional Medicare does not cover. The elder can visit any provider of their choice that accepts Medicare. There are co-pays and deductibles with all medigap products.
-----Medicare PPO and HMO products-Medicare Advantage Plans: For these plans, there is no 20% out of pocket expense. The monthly $105 deducted from the elder's social security check covers the plan cost in full. Depending on the company and plan chosen by the elder, there may be deductibles and co pays with these plans. The elder must use providers within their chosen advantage plan, or they will be charged penalties for using out of network providers. As an example, if the elder has a diagnosis of cancer and chooses to go to the top cancer surgeon in their area, this surgeon may not accept their Medicare advantage plan. In this case, the elder would be charged the private rate, have to pay the doctor's rate, then submit the bill to their advantage plan for a small reimbursement. But for the most part, the elder is suddenly a private paying client, even though they do have insurance. The provider must be a part of their health plan for the payment to be covered in full, with a co-pay.
-----So, which is better?
-----Traditional or Standard Medicare or a Medicare Advantage Plan? Well, the traditional plan, which limits the cost billed by the charge that Medicare approves, leaves the elder with a 20% responsibility. This responsibility
can be met privately, or can be payed by a "medigap" policy that has a monthly
charge, usually $250 a month or so. But with the traditional Medicare, the costs are capped by the approved amount Medicare places on the services provided. With the advantage plans, there is no 20% responsibility, as long as the elder limits medical care to in-network providers. There may be a co-pay per visit, but there is no need to pay a monthly medigap policy fee. The downside is that if there truly is a medical emergency and the elder wants the best care available, many times the best doctors do not belong to any "advantage" plans.
-----It ends up being a calculated risk, or even a gamble. To save in the long run, as long as the elder is healthy, the advantage plans are wonderful. But in a short-term emergency situation, to access the best care money can buy, the elder should keep traditional Medicare and afford the monthly medigap policy fee. But one never knows what the future will bring. If you are a gambler, go with the advantage plans. If you are a "slow-and-steady wins the race" person, keep your traditional medicare and pay for the medigap policy.