Medicare 20201: Comparing and choosing plans, and how to use the charts

The Medicare guide has been created to help you compare plans in your county and see the key benefits of each. Some plans are available in multiple counties and some only in one. In addition, special needs plans are included in the guide and aimed at people who have specific chronic conditions or limited incomes. There are more of these plans this year, and they tend to provide substantial savings along with targeted care for those who are eligible.

Here are some of the abbreviations and phrases you may see:

HMO: Health Maintenance Organizations offer the lowest co-pays and premiums, but they limit you to network doctors and facilities. Your care is coordinated through a primary care physician, and referrals usually are required to see specialists except for emergency care and certain services like yearly mammograms.

HMO-POS: These hybrid HMOs have a Point of Service option, allowing you to go outside the plan’s network for some services -- but with higher co-pays. You may need a referral.

PPO: A Preferred Provider Organization allows you to see any physician in the network, no referrals required. Most also provide some out-of-network coverage with higher co-pays. PPOs typically have the highest premiums and costs. If you want drug coverage, you must join a PPO plan that offers it.

PFFS: A Private Fee-for-Service plan makes it possible to see any doctor or provider that accepts the plan’s payment terms. Sometimes, the plan does not offer drug coverage, but you can purchase a separate drug plan to obtain coverage.

SNP: Special Needs Plans offer lower-cost options to those with limited incomes or chronic health conditions. There also are special needs plans for nursing home and assisted living residents. All plans must provide prescription drug coverage.

MSA: Medical Savings Account Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.

PDP: Prescription Drug Plans, or stand-alone plans, offer only drug coverage with no medical benefits. These plans appeal to people who want to stay on traditional Medicare, which does not cover medications.

You pay only your Part B premium: This phrase applies to plans that accept what Medicare takes out of your Social Security check as full payment. Some plans may cover part of your Part B premium, others may charge you an additional premium.

Preferred and standard pharmacies: Many plans offer better drug prices through their preferred pharmacy networks. To get the best plan deal, make a list of all your medications and check prices with different insurers.

Tiers: Plans put prescription drug coverage into up to six categories or tiers. Each plan can divide its tiers in different ways and each tier costs the member a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier. . .

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