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Health Care Reform:

Health Insurance & Affordable Care Act

How to Pay for What Medicare Doesn’t Cover

Medicare Advantage (Part C)

While Medigap and Prescription Drug Plans are things you add to Original Medicare, Medicare Advantage plans are an alternative to Original Medicare.

Medicare Advantage plans are  private health plans that contract with the federal government to offer Medicare benefits to enrollees. Medicare Advantage plans may cover things that Original Medicare doesn't. For instance, most have built-in drug coverage. Some may have additional benefits -- like dental, hearing, vision, or wellness programs. You may have to pay an extra monthly fee for a Medicare Advantage plan on top of your monthly Medicare fee. In addition, you must go to the providers in the plan’s network.

If you sign up for Medicare Advantage, you can't get a Medigap plan. But if your Medicare Advantage plan doesn't already have drug coverage, you can add on a Prescription Drug Plan.

Each state has many health plans to choose from. If you pick one, you'll use it instead of Original Medicare.

Medicare Advantage plans can change each year. What's covered might change. How much you pay may change, too.

More Ways to Lower Your Costs

Even if you have a Medigap plan and prescription drug coverage -- or a Medicare Advantage plan -- you'll still have medical costs that aren't covered. You may qualify for financial aid to pay all or part of these costs. There are also some other programs and pointers that may help.

Qualified Medicare Beneficiary (QMB) Program. Available to low-income Medicare beneficiaries. This program helps you pay for your Medicare Part A and Part B premiums, as well as co-insurance, copayments, and deductibles. Contact your state Medicaid office to find out if you qualify.

Specified Low-income Medicare Beneficiary (SLMB) Program and Qualified Individual (QI) Program. These two programs are largely the same, but with different eligibility standards. The programs help low-income Medicare beneficiaries pay for their Medicare premiums. Contact your state Medicaid office to see if you qualify.

Qualified Disabled and Working Individuals (QDWI) Program. Individuals who qualify for Medicare because of disability, rather than age, may receive help paying their Medicare Part A premiums through this program. Contact your state Medicaid office to apply.

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