Medicare

Before choosing a plan we want to be sure you know the difference between your many options; In particular how Medicare Supplements and Medicare Advantage Plans differ.

Medicare Supplement Insurance Plans

A Medicare Supplement Insurance Plans is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement. Which supplement insurance plan, A thru N, determines what deductibles, co-pays and co-insurance of the remaining 20% will be covered. It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP).

Medicare Advantage

A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan a private company takes over for Medicare (you remain in the Medicare system with all your rights and privileges but Medicare is no longer responsible for your bills). These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan it is important to remember several things.

First, most Advantage Plans have Networks so you want to make sure your Doctor, Hospital, and auxiliary care are within the network. Second, Advantage Plans have co-pays associated with them. Third, most Advantage Plans have the Part D “built in” which is a nice bonus. Lastly, Advantage Plans typically have value added benefits. These benefits vary between plans but typical benefits include Health Club membership, limited dental, vision and hearing.

Prescription Drug (Part D)

Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you're first eligible, and you don't have other creditable prescription drug coverage, or you don't get Extra Help, you'll likely pay a late enrollment penalty. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

Not all Plan D’s, Prescription drug plans are the same. Although they are required to be at least as good as the Medicare model they can vary greatly in premiums, deductibles, co pays and specific drugs (formulary) that are covered. It is important to check which best suits your needs and continue to check each year because the formularies, co pays and premiums can change every year.

Because these plans vary even from county to county, we strongly recommend that you talk to an independent insurance agent to help you choose the one that best suits your needs.

2 ways to get drug coverage

1. Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage.

What drug plans cover

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.

A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.