Medicare: What are your options?

PFNow! has put together some general information from various sources. This article is not meant to recommend any particular plan. Please contact your local SHIP (State Health Insurance Assistance Programs) organization https://www.shiptacenter.org/ ; 1-877-839-2675 to get customized cost for your specific coverage needs. They can provide one-on-one assistance with reviewing health or prescription drug plan options that are right for you.

OPTION 1: Government-Managed Medicare (“Original Medicare”)

Original Medicare coverage is managed by the federal government. In most cases, you can go to any doctor, health care provider, hospital or facility enrolled in Medicare. One advantage is, you do not need a referral to see a specialist. Original Medicare consists of several parts and generally there’s a cost for each service. 

Part A

• Covers: Hospital Insurance. E.g., inpatient hospitalization, care in a skilled nursing facility, hospice care and some home health care
• Cost: is premium free for people who have contributed 10 years to social security and people that meet certain other criteria

Part B 

• Covers: Medical Insurance.  E.g., doctor’s services, outpatient care, medical supplies, therapies, and preventive services. 
• Costs: Most people pay a standard monthly premium of $148.50 for this, but this can vary based on your yearly income.

Medigap Plan (supplement to Medicare)

• Covers: the costs not covered by Medicare.  E.g., the 20% “gap” which are self-paid costs not covered by Medicare.
• Costs: monthly premium varies based on rate from private insurance company to cover the “gap” in Medicare coverage. 

Part D (Medicare drug plan). 

• Covers: Prescription costs. Most prescriptions are not covered by original Medicare but you can add drug coverage by joining Part D. 
• Costs: monthly premium varies depending on the private insurance company, your monthly income and the medications you need covered. 

OPTION 2: Privately-Managed Medicare (Alternatives to Original Medicare)

Medicare Advantage or Medicare HMO Plan (sometimes referred to as “Medicare Part C”) is an alternative to Original Medicare, whereby you can get Medicare benefits through a private health insurance company. You can choose from approximately 50 plans that provide coverage at a lower premium. Most such plans are health maintenance organizations (HMOs) or preferred provider organizations (PPOs).  

In this plan, you pay a monthly premium for coverage of inpatient (Part A), outpatient (Part B) and prescription drug services (Part D). Also, many plans offer benefits such as dental coverage or gym memberships. 

Finally, if you have Medicare Advantage, only services within the particular network can be used and you would need a referral to see a specialist. 

Pulmonary Fibrosis NOW! hopes that this information helps to ensure a smoother enrollment process for you and your loved ones. Remember, you are your biggest advocate so make sure to do your research, ask questions, and choose a plan that covers all your individual anticipated pulmonary fibrosis healthcare needs. Together, we can #fightPFNOW!

To connect with others who have or are impacted by PF, join our online community forum, and attend our virtual support groups on Zoom.