Medicare Options

Just what are those Medicare options?

Medicare Supplements

Medicare Supplements do JUST as they say. Supplement Medicare. That’s a strange statement, until you understand just what it means. This means, you will need both Medicare Part A & Part B.

With a Medicare Supplement, medicare is billed FIRST, so you will have to see providers that accept both Medicare, and you.

When Medicare is billed, it then pays it’s share towards any approved charges. Once approved, there are often deductibles, co-pays and/or percentages of the costs that are left to you. These are also called the Medicare “gaps”. Medigap is another term for Medicare Supplement.

That is why, if you elect a supplement, that you are aware of which plan meets your particular level of financial need. The more of those that you want the Supplement to pay, the more expensive the monthly premium is.

Keep in mind, Supplements do NOT include Part D. So you will need to consider a stand alone Part D plan, when considerring a supplement option.

Medicare Part D (prescription drug plans)

Looking for a Quote for Medicare Advantage or Part D?

I created a helpful PDF on how you can use Medicare.gov, when it comes to Part D.

“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.” This is straight from Medicare’s website. it’s a simple enough statement, but, there are things you need to know in addition to this.

Each drug plan has it’s own formulary (list of medications they cover)
Drug companies place their covered drugs into different “Tiers” , and each tier typically has different costs to you. Generally, the higher the tier, the higher the cost.
Plans can also have Deductibles, Quantity Limits, Prior Authorizations or Step Therapy limitations. I strongly encourage people to get help when deciding on Part D coverage. A great resource is www.medicare.gov
the formulary can change at anytime under Medicare guidelines. And if a change affects a medication you are currently taking, then they have to:
- Provide written notice to you at least 60 days prior to the date the change becomes effective.
- At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.

Late Enrollment Penalty (LEP):

If you decide not to join a Medicare Prescription Drug Plan (Part D) 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.
Medicare keeps track of each month that you go without Part D coverage. The penalty is a MONTHLY penalty which is calculated by taking 1% of the National Average premium for a Part B plan x the number of months you went without “creditable” coverage.
The LEP is paid forever, unless you qualify for Extra Help or Medicaid.

Coverage Gap or (Donut Hole)

The coverage gap is when the COST of your medications (that is what you pay PLUS what the insurance company pays), reaches a certain level each year.

Medicare’s website explains this best

Most Medicare Prescription Drug Plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2021, once you and your plan have spent $4,130 on covered drugs, you’re in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Once you’ve spent $6550 out-of-pocket in 2021, you’re out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.

Medicare Part C (aka Medicare Advantage)

AGAIN.. Medicare says it best:

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 still have Medicare. You’ll get 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 typically combine the benefits of Part A (Hospital) and Part B (Doctors and outpatient) and sometimes include coverage for Part D (medications). In addition. some may include other benefits, not typically covered by Medicare (gym memberships, dental, vision, hearing, transportation, over the counter product allowences). While you will need to have and keep both Medicare Parts A &B, Medicare Advantage plans are NOT SUPPLEMENTS.

Medicare Advantage plans may have their own monthly premium, deductibles, co-pays and coinsurance amounts for services. But they also would have limit on the out of pocket costs for your A & B services.

They may also have rules on how you can access the services, such as needing a referral, or working within a network.

The plans can change from year to year, so it is important to review your plan options each year, and during the Annual Enrollment Period (Oct 15th – Dec 7th)

What is commonly considered important to find out about in Medicare Advantage plans, is how your doctors and medications are covered.