There are gaps in the coverage Original Medicare provides. Medicare pays a share of the Medicare-approved amount, and you pay your share — co-insurance, copays and up-front deductibles. In some cases, you may be charged more than the Medicare-approved amount. If you experience a serious illness or have multiple conditions, these out-of-pocket costs can become significant.

Medicare is a federal health insurance program for people 65 years old or over and for certain disabled people under 65 years of age. You are automatically enrolled in Medicare hospital insurance (Part A) when you apply for Social Security benefits – usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility. Part B covers physician and outpatient hospital services.

Once you become a Blue Medicare HMO or Blue Medicare PPO member, you transfer the administration of your Medicare benefits to Blue Medicare HMO or Blue Medicare PPO. This means you maintain your status as a Medicare beneficiary, plus gain the enhanced coverage available through your Blue Medicare HMO or Blue Medicare PPO health plan. You will receive a Blue Medicare HMO or Blue Medicare PPO Member ID card that you will present when using your Blue Medicare HMO or PPO benefits.

Assignment is an agreement between Medicare and doctors, other health care providers, and suppliers of health care equipment and supplies (like wheelchairs, oxygen, braces, and ostomy supplies). Doctors and suppliers who agree to accept assignment accept the Medicare-approved amount as payment in full for Part B services and supplies. You pay the coinsurance and deductible amounts.

The Original Medicare Plan is a "fee-for-service" plan. This means you are usually charged a fee for each health care service or supply you get. This plan, managed by the Federal Government, is available nationwide. If you are in the Original Medicare Plan, you use your red, white, and blue Medicare card when you get health care. If you are happy getting your health care through the Original Medicare Plan, you don't have to change to another Medicare health plan.

Monthly plan premium varies by plan and geographic area. Some plans have no additional monthly premium. Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS), and specialty plans

Medicare doesn’t pay for all of your healthcare costs. There are “gaps” or “out-of-pocket” costs that you must pay in the Original Medicare plan. The chart below gives some examples of these gaps. A Medicare Supplement policy covers some, but not all, of the gaps in the Original Medicare plan.

HMO is an alternative to Original Medicare and features specific lists of doctors, hospitals, and other providers that you must use to receive benefits. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, steep reductions in coinsurance when you see a doctor, a drug benefit plan, and wellness or fitness programs. If you select a Medicare Advantage HMO, it is an alternative to your Original Medicare coverage.

With a Medicare Advantage PPO, you can see any doctor you want. However, if you use a doctor who participates in the network, you get a better benefit and lower copayment/coinsurance than if you visit a non-network doctor. Plus, referrals aren’t needed, and you don’t have to see a primary care physician first. In addition to prescription drug benefits, Medicare Advantage PPOs may offer other benefits such as dental, vision, and nutritional supplements.

With a Medicare Advantage PFFS plan, you have the freedom to select any doctor, hospital, or healthcare provider who accepts Humana’s payment terms and conditions – without worrying about referrals or a list of doctors who participate in the plan’s network. PFFS plans feature limits on out-of-pocket expenses, coverage for emergency and urgent care, and in some cases, a prescription drug benefit. If you select a PFFS plan, it is an alternative to your Original Medicare coverage.

A Medicare Supplement insurance plan helps cover the “gaps” in coverage that are left unpaid after Original Medicare pays its portion of your healthcare expenses. For this reason, these plans are often referred to as Medigap plans. Unlike a Medicare Advantage plan, which is an alternative to your Original Medicare benefits, a Medicare Supplement plan is purchased in addition to your Original Medicare benefits.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

Because your Medicare supplemental insurance plan is guaranteed renewable, you will still have insurance coverage if you move. If you move to a new state, however, the Medicare supplement insurer may quote you a different premium. If you have a Medicare Select insurance plan, which contain network restrictions, you must change your Medicare insurance coverage.

Even if you do not use many prescription drugs now, you should still consider joining a Medicare Prescription Drug Plan. Medication costs continue to rise each year -- dramatically, in some cases. As you age and your prescription needs change, your reliance on prescription drugs and expenses may increase. In addition, for most people, joining as soon as they are eligible means they will pay a lower monthly premium than if they wait to join at a later date.

established by CMS, if you do not join a Medicare Part D plan when you first become eligible, you may have to pay a 1% penalty for each month you delay. The penalty will be added to your monthly premium. The best way to avoid additional fees is to sign up for a Medicare Part D plan in the three months before or after the month of your 65th birthday or as soon as you become eligible under certain special circumstances.

The Original Medicare Plan is the traditional fee-for-service system that covers your health care needs. But not everybody is eligible for both parts. Medicare pays its share of the bill and you pay the balance. You may choose to go to any doctor, hospital, or other health care provider, like a home health agency, which accepts Medicare payment.

It usually takes about a month for this change to occur. Once your plan receives your request to leave, you will automatically return to Original Medicare on the first day of the next month. Remember, if you change to another managed care plan, that plan will tell you when your new benefits are effective. Usually this will occur on the first day of the next month after your enrollment form is received.

Assignment is an agreement between people with Medicare, their doctors and other providers, and Medicare. The person with Medicare agrees to let the doctor or other provider request direct payment from Medicare for covered Part B services, items, and supplies. Doctors or providers who agree to (or must by law) accept assignment from Medicare can’t try to collect more than the Medicare deductible and coinsurance amounts from the person with Medicare, their other insurance, or anyone else.

A PFFS plan covers all of the benefits covered under Original Medicare. In addition, a PFFS plan may cover some of the cost sharing under Original Medicare and additional benefits not covered under Original Medicare. For example, Care Assured plans cover an unlimited number of days in the hospital whereas Original Medicare does not.

You will automatically return to Original Medicare if you leave your plan. You do not need to re-enroll. You may leave your plan by calling the Social Security office, or notifying the plan that you wish to leave and asking to disenroll from your Medicare managed care plan.

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

You can get personalized information at www.medicare.gov on the web or by calling 1-800-MEDICARE (1-800-633-4227). Your State Health Insurance Assistance Program (SHIP) can provide you with free health insurance counseling. You maybe able to access assistance with enrolling in a Part D plan from a local community-based organization.

Many people with limited income and assets will qualify for extra help with paying for their prescriptions. The extra help may cover the drug plan's monthly premium and/or some of the drug co-payments or co-insurance amounts. People with the lowest incomes and fewest assets will receive the most help. For more information on how to get extra help with prescription drug costs and how to apply, call the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov on the web.

As soon as you become eligible for Medicare, you are no longer eligible for the Individual insurance coverage. Eligibility under Medicare includes turning 65 years of age or being eligible for Medicare disability. If you do not qualify for Medicare, you may remain on the Individual policy.