These plans are run by private insurance companies. People can either buy these plans by contacting the specific insurance companies or buy the coverage on the internet. Most of the times, these plans are given to employees as part of their benefits package for employment.
a. Usually provide good network of physicians and hospitals
b. Now many plans have high deductibles, co-payments, and/or co-insurance
c. Usually run by large healthcare insurance companies
These plans are offered on the healthcare exchanges, which are run together by the states/federal government. People can sign up for such plans on the exchanges (usually online) that are appropriate for their specific state.
a. Usually have limited physician and hospital networks
b. Open enrollment is only a specific portion of the year, and enrollment must occur during this period (unless the patient has a special circumstance, as allowed by the exchange)
c. The plans are split up into categories: Bronze, Silver, Gold, Platinum.
d. Based on category of plan, deductibles and overall medical coverage vary widely. You must be careful and research the coverage of the plan fully prior to signing up to avoid future unwanted bills.
e. Be Careful: Many insurances that list on the exchange, go under the same name as their private/medicaid/medicare plans, but have much more limited coverage than the other plans. Please research the coverage of the specific Exchange Plan you are signing up for, and not just the coverage of the company that the plan is provided by.
This is a government run program for the elderly and the disabled. This program is not need-based. It is split into:
A. Hospital Coverage
B. Medical Coverage
C. Medical Advantage Plans
D. Prescription Drug Coverage
If you have the basic Medicare (usually entails A and B), you are covered for 80% of healthcare costs of that coverage (Medicare also has a small yearly deductible). The rest of the 20% is the patient’s responsibility. This can add up quickly, so almost all of the patients have some sort of coverage for the 20%. The options include:
a. Medicare Advantage Plans (part C Medicare): Usually is run by private insurance companies. By signing up for this plan, the private insurance plan becomes your primary insurance company. As such, the coverage rules/network of physicians and healthcare facilities are run by the company offering the Advantage Plan. The main benefit of this type of plans is that usually the monthly premium payments are very low (some plans offer 0 premium). These plans usually have low copayments as well, and of course they cover 100% of the healthcare costs (besides copayments/small fees), as opposed to the 80% covered by Medicare.
b. Medicare Supplementary Plan: Usually run by private insurance companies. These plans cover the 20% healthcare expenses that Medicare does not. Your primary insurance is still considered Medicare, and most of the time, the physician/hospital networks are part of the general Medicare network. The Supplementary plan pays the rest of the 20% of the expenses (as long as they are within the rules of the coverage). These plans are not cheap, and can have monthly premiums as high as $400.
c. Medicaid-for those patients who have low income and qualify for Medicaid, they can get Medicaid and it would cover the 20% of the healthcare costs Medicare does not. Your primary coverage continued to be Medicare, and most of the physician/hospital networks are any that take Medicare.
When enrolling in Medicare, please make sure you enroll in all of the parts that you require (usually at least part A and part B). If you enroll only in part A (since part B has a separate premium), you do not get coverage for outpatient visits/treatments, and more importantly you might get into financial trouble if you go to a hospital and you are put on “Observation Care”, which gets billed under part B coverage.
This is a government run need based medical insurance plan. If you meet the income requirements as usually set by the state, you can obtain Medicaid as medical coverage. New York state recently has tried to place patients who qualify for Medicaid into managed medicaid program. If you have Medicaid, you can chose to have:
a. Managed Medicaid Plan-offered by private insurance companies. These plans become your primary insurance and determine the copayments/benefits/coverage networks of your insurance. If you enroll in a medicaid managed plan in New York, you have to follow the rules of that plan and are limited to the network of providers that participate in that plan. For some of these plans, the networks are very limited. As such, please do your research and compare the different managed medicaid plans and make the decision that is best for you.
b. Medicaid-although rare, you can have “straight Medicaid”. In such cases, your primary insurance is Medicaid and your benefits/provider networks are based on Medicaid rules. As stated above, the recent push by New York State to enroll Medicaid patients into Managed Medicaid Program have made this option very limited.
Special program in New York State where patients who are dual eligible (Medicare and Medicaid) enroll in a plan (usually provided by private insurance companies) that covers all of their healthcare costs, and includes long term care coverage. These plans aim to create more communication between the patient’s healthcare team, the plan, and facilities involved in the patient’s care. Although it has the benefit of better communication among healthcare provides, a negative of the plan is that the coverage networks and fees are set by the individual plans (and the plan becomes the patient’s primary insurance).
Managed Medicaid Plan-offered by private insurance companies. These plans become your primary insurance and determine the copayments/benefits/coverage networks of your insurance. If you enroll in a medicaid managed plan in New York, you have to follow the rules of that plan and are limited to the network of providers that participate in that plan. For some of these plans, the networks are very limited. As such, please do your research and compare the different managed medicaid plans and make the decision that is best for you.
After retirement from the military, these patients are usually covered by the VA Medical System. Tricare insurance functions similarly to a private insurance with a fairly wide provider network and good benefits. The VA system functions as a provider of all needed medical services, and patients have to obtain their care at VA facilities and be seen by VA facility providers.