Medicare

Medicare

Medicare Supplements:

A Medicare supplement (Medigap) insurance, sold by private companies. 

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover.  

If you have Original Medicare and you purchase a Medigap policy, claims should be sent to Medicare and Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share; a Medigap policy supplements your Original Medicare benefits.

The policy is portable, meaning you can have the policy anywhere in the USA. You must receive care from a medical provider that accepts Medicare. 

The benefits are guaranteed and cannot be changed. (Premiums can change.)

If you are eligible for Medicare after January 1, 2020 (Part A Date) you will be responsible for the Part B deductible on your Medigap Supplement.

Part D Drug Coverage:

When you turn 65 you must have Part D coverage that is equal to the national average plan. It can be through your employer plan, which must be deemed credible coverage or purchase a Part D Drug Plan. 

You cannot go more than 63 days without a Part D Drug plan before a penalty will be due. The penalty remains on your plan for life. 

Enrollment into a Part D Drug Plan is allowed during the Open Enrollment Period, when you age into Medicare or during a specific Special Enrollment Periods if you qualify.   

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, you’ll receive your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans cover all Medicare services approved by Medicare. 

Medicare Advantage Plans may also offer extra coverage.

Medicare pays a fixed amount for your care each month to the insurance company offering the Medicare Advantage Plan. 

Each plan can have different rules for how you access services, like:

• Whether you need a referral to see a specialist
• If you must go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules may change yearly, and the benefits are not guaranteed.

The plan may include Part D drug coverage as well.

What you pay in a Medicare Advantage Plan:

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

• Whether the plan charges a monthly premium.
• Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
• Whether the plan has a yearly deductible or any additional deductibles.
• How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
• The type of health care services you need and how often you get them.
• Whether you go to a doctor or supplier who accepts assignment (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).
• Whether you follow the plan’s rules, like using network providers.
• Whether you need extra benefits and if the plan charges for it.
• The plan’s yearly limit on your out-of-pocket costs for all medical services.
• Whether you have Medicaid or get help from your state.

Medicare Cost Plans:

COST plans have some of the same rules as Medicare Advantage Plans. However, each type of plan has special rules and exceptions. 

Medicare Cost Plans are a type of Medicare health plan available in certain areas of the country.

Here are important facts about Medicare Cost Plans:

• You can join even if you only have Part B.
• If you have Part A and Part B and go to a non-network provider, the services are covered under Original Medicare. You would pay the Part A and Part B coinsurance and deductible.
• You can join anytime the plan is accepting new members.
• You can leave anytime and return to Original Medicare.
• You can either get your Medicare prescription drug coverage from the plan (if offered), or you can join a Medicare Prescription Drug Plan (Part D).

Another type of Medicare Cost Plan only provides coverage for Part B services. These plans never include Part D. Part A services are covered through Original Medicare. These plans are either sponsored by employer or union group health plans or offered by companies that don’t provide Part A services.

Costs plan may or may not include Part D drug coverage.

Choosing a Medicare Plan:

There are many factors in choosing your Medicare plan. 

Should you stay on your employer plan (special rules apply.) 

Do you have an HSA plan? (Special Rules apply to HSA’s and contributions.)  

Does your employer need to complete a form for you to verify employer coverage?

Do you need Part B? (If Part B is not applied for when eligible a penalty may apply.) 

Do you need Part D? (If Part D equivalent coverage is not had at age 65 a penalty may apply). 

Do you have all the required Part D notices? 

Does IRMA apply? (If household incomes are over a specified amount, stated by Medicare yearly, you may be responsible for an additional premium applied to your Part B and Part D.) 

Does the plan you’ve chosen cover your doctor and prescriptions?

Let us help you answer these questions are more!