It is no secret that the Medicare Part D plan, and its associated fee-for-service payment plans, are extremely popular among both seniors and health insurance consumers. But as the program continues to evolve, many new challenges are emerging. If you’re not familiar with Medicare’s current system, it is recommended that you read on for more information about what’s new and upcoming and find more at the Medicare Solutions Team.
The original Part D plan was first created in 1965 to help those with limited financial resources to pay for routine healthcare. Initially, it allowed for an individual plan that covered preventive care at pharmacies, hospital stays, outpatient visits, and X-rays. Subsequently, Medicare Part D expanded the program to include prescription drugs as well as other services including mental health and nursing home care.
Over time, Medicare Part D has become more complex, but in general the program remains simple and straightforward. It does have a few limitations, however, so it is important to understand these issues and how they impact your insurance coverage. These limitations include a change in payment rates and eligibility requirements as well as eligibility for supplemental plans, such as supplemental insurance plans (SIPs) and managed care plans (MCPs), and a transition from the fee-for-service payment to a fixed monthly payment rate.
To take advantage of the advantages of Medicare Part D, there are several items that you should consider. The most important aspect to understanding how these Medicare plans work is knowing exactly how Medicare pays its providers. Medicare Part D requires that you select a primary care provider from a list of preferred providers (providers who agree to accept a portion of Medicare payment rates as their rates of payment for covered services) or you will be enrolled into the Part B Plans (Part B Plans cover a wider range of services than Preferred Provider Organizations).
While Medicare Part D is intended to cover routine health care and preventative care, it also offers the benefit of prescription drug coverage. While the Part D plans do not pay more for prescriptions than a traditional private plan, some of the newer plans may offer a lower co-payment when a prescription drug is needed due to illness or injury.
Another benefit of Medicare Parts A and B is that they can also cover emergency services. But if an emergency medical service is needed for an emergency room visit or hospital stay, you may need to see a specialist, such as an emergency physician. You may also qualify for a Medigap policy which pays an additional fee for coverage of emergency room visits.