Sunday, November 19, 2017
News Roundup

Medicare health plans with drug coverage

RECOMMENDED READING


What's in this chart

Type: The chart below shows four types of health plans with drug coverage — HMO, PPO, HMO-POS, PFFS. They are explained on the next page.

Premium: The monthly charge for the plan. This is in addition to whatever monthly Part B payment you make to Medicare.

Part B rebate: Some plans pay part of your monthly Part B premium, which for most people will be $104.90.

Doctor copay: This is your cost every time you see a doctor. The first dollar figure is for primary care physicians, the second for specialists. Costs are listed for physicians inside the network (Net:) and outside the network (Out:).

Hospital copay: This is your cost for inpatient hospital care, for each admission. Costs are listed for hospitals inside the network (Net:) and outside the network (Out:).

Estimated total cost: Medicare's estimate of annual out-of-pocket costs under this plan, including Part B premium and drugs. It is based on an average person in good health, but could vary greatly depending on the drugs you take and what services you actually need. The best way to assess the projected cost of different plans is with Medicare's Plan Finder at medicare.gov.

Out-of-pocket cap: Your maximum payment for the year inside the network (Net:) and outside the network (Out:). The lower the cap the better.

Network size: The total number of providers in a network, including doctors, hospitals and other services. Some networks cover a specific region, others the entire state. Before signing up with any plan, check its provider network to see if its hospitals and doctors are acceptable to you.

Generics in the gap: Whether a plan pays for generic drugs in the coverage gap, or "donut hole,'' which begins when total drug costs hit $2,850 and ends when your out-of-pocket costs reach $4,550.

Rating: Medicare rates plans from 1 to 5 stars, based on customer satisfaction and certain health measures. The top rating is five. Plans that have received a low rating three years in a row earn a "warning" symbol.

What's not in this chart

Special Needs Plans: See explanation below.

Copayments for other services: Plans usually charge copayments for drugs, skilled nursing homes, ambulances, emergency rooms and many other services. Check individual plans for these details.

Goodies: Some plans offer some dental, hearing and vision coverage, exercise classes, transportation to the doctor and other extra benefits. Check plans for details.

Health plans without drugs: A few plans are cheaper because they do not offer drug coverage, but choosing those plans can result in stiff penalties in subsequent years unless you receive comparable drug coverage elsewhere

Health plans: how they differ

Medicare allows several types of private health plans, which cover all your care. Here is how they differ:

HMO (Health Maintenance Organization): Generally require you to use providers within a network, unless an emergency forces you to seek treatment elsewhere. A personal physician usually coordinates your care and must approve visits to specialists.

PPO (Preferred Provider Organization): Also encourages you to use providers within a network, with low copayments, but also allows you to use providers outside the network at a higher cost. Usually allows you to see specialists within the network without prior approval of a personal physician. "Regional'' PPOs generally have larger networks, such as the entire state. Some bigger companies allow you to use their PPOs in other states, useful to snowbirds. Verify before signing up.

HMO-POS (HMO-Point of Service): A hybrid between an HMO and PPO. Usually requires you to stay within a network and seek approval of a personal physician before seeing network specialists. But also may cover some care outside the network, with a referral. Some POS plans approve very little coverage outside the network, so check plans for details.

PFFS (Private Fee for Service): Has network, but also allows members to get care outside the network if the provider will accept the plan's payment, which many do not. Make sure your providers will accept payment before incurring bills.

Special Needs Plans: People with certain chronic conditions like diabetes and COPD can sometimes qualify for a Special Needs Plan, which may include extra services for managing their disease. Make sure you qualify before purchasing. People living in nursing homes may also qualify for special plans, as can people on Medicaid.

• Special Needs Plans are not listed in this chart. See medicare.gov for information.

Comments
Sunday morning QB, playoff edition

Sunday morning QB, playoff edition

Player of the Week | Michael Penix Jr., Tampa Bay TechPenix, a Tennessee commit, has been good all season and it seems as if he’s getting even better in the playoffs. On Friday night against Palmetto in the Class 7A region semifinals, he was too ...
Updated: 11 hours ago

Updated: 10 hours ago
Lightning finds its game too late, loses to Islanders

Lightning finds its game too late, loses to Islanders

TAMPA — The firepower showed up in the third period.Yanni Gourde and Ondrej Palat scored 13 seconds apart. Gourde scored again.Suddenly it was a one-goal game, and the Lightning appeared on its way to one of those comeback wins that would be remember...
Updated: 10 hours ago
No. 14 UCF rolls Temple 45-19, heads to War on I-4 unbeaten

No. 14 UCF rolls Temple 45-19, heads to War on I-4 unbeaten

PHILADELPHIA — There were so many reasons for UCF coach Scott Frost to worry about his team’s focus. With a huge game against USF looming, playing an improving Temple team in a stadium where the empty seats outnumbered the filled ones by about a 3-1 ...
Updated: 11 hours ago
Gerald McCoy to Ndamukong Suh: ‘Let them remember us’

Gerald McCoy to Ndamukong Suh: ‘Let them remember us’

TAMPA — In the spring of 2010, one of the biggest debates during the week leading up to the NFL draft was which defensive tackle would be selected first: Nebraska’s Ndamukong Suh or Oklahoma’s Gerald McCoy.Both figured to be highly productive NFL pla...
Updated: 12 hours ago
No. 2 Miami finishes on 30-0 run, tops Virginia 44-28

No. 2 Miami finishes on 30-0 run, tops Virginia 44-28

MIAMI — After Miami clinched the first Atlantic Coast Conference Coastal Division crown in program history, upset the then-No. 3 team in the country, claimed one of the top four spots in the College Football Playoff rankings and after many of the nat...
Updated: 12 hours ago
Bucs’ belief in Jameis Winston has been shaken

Bucs’ belief in Jameis Winston has been shaken

TAMPA — Belief is the biggest attribute a quarterback can bring to his team. Belief in his talent. Belief in his commitment to winning. Belief in his ability to bring everyone together and have his voice lead the path forward.But the belief the Bucs ...
Updated: 12 hours ago
Topkin: As Rays start dealing, how far will they go?

Topkin: As Rays start dealing, how far will they go?

After collecting intelligence at last week’s GM meetings, the Rays soon will launch their offseason mission of trading at least a couple of veterans to reduce payroll.The question is how far they will go — how many players they deal, and how big of n...
Updated: 12 hours ago
Bucs-Dolphins: Things to watch in Sunday’s 1 p.m. game

Bucs-Dolphins: Things to watch in Sunday’s 1 p.m. game

TAMPA — Can the Bucs pull off back-to-back wins with a backup quarterback? Win a game on the road for the first time this season? Politely hand the unnamed trophy for the state’s worst football team back to the Dolphins?With WR Mike Evans back from h...
Updated: 12 hours ago
Florida State routs Delaware State 77-6

Florida State routs Delaware State 77-6

TALLAHASSEE — Florida State coach Jimbo Fisher longed for his team to play in this type of game throughout its disappointing season.After Hurricane Irma caused a three-week layoff between FSU’s first two games, forcing it to play 11 in a row to finis...
Updated: 12 hours ago