Part A (Hospital Insurance):
Helps cover: inpatient care in hospitals, skilled nursing facilities (short-term rehab), hospice care, and home health care.
Part B (Medical Insurance):
Helps cover: outpatient care like doctor visits, labs, emergency room visits, preventive care like yearly wellness exams, durable medical equipment like CPAP machines, wheelchairs, diabetic monitoring supplies, and more. The Medicare & You handbook has a complete listing.
Part D (Drug coverage):
Helps covers: the cost of prescription medications. Since Original Medicare does not pay for most prescription medications, it is necessary to obtain a drug plan (Part D) either as an add-on to Original Medicare or as part of a Medicare Advantage program. Medicare drug plans are administrated by private companies.
Before enrolling in a Medicare plan, it is extremely important to understand the different plans available to you and the restrictions and/or timelines that may impact your decision or future options. Each person is different with regards to their health needs, budget and tolerance for risk. For this reason, our first meeting with you will be spent getting to know you better and educating you on the different parts of Medicare so that we can make tailored plan recommendations and you can make informed choices.
Medicare Supplement Plans, also called Medigap, is a coverage option that pays secondary to Original Medicare. Since Medicare Parts A & B (Original Medicare) do not pay 100%, a Medicare Supplement plan can help pay leftover amounts like deductibles and/or coinsurance. The available Supplement Plan options are standardized by the government but sold by private insurance companies. You will pay a premium to the private insurance company for this additional coverage.
Medigap plans are designed to work with Original Medicare and cannot be combined with a Medicare Advantage program. You may have to pass medical underwriting in order to purchase a Medicare Supplement plan if you do not do so when you first become eligible for Medicare Part B or turn age 65.
Medicare Advantage Plans, also known as Medicare Part C, are a way to obtain your Medicare A & B benefits through a private insurance company. Part C plans are offered by private insurance companies but are funded and regulated by the Federal government.
When you enroll in a Part C plan, the insurance company becomes your Medicare “administrator” and you carry their ID card, use their network of providers, they pay your claims, and you utilize their customer service centers instead of 1-800-Medicare. Part C plans include Medicare A & B benefits and often include extra benefits like Part D, dental, vision, hearing and a gym membership. Medicare Advantage Plans are not the same as a Medicare Supplement.
Medicare Drug Plans, usually known as Medicare Part D or PDP (Prescription Drug Plan), help cover the cost of prescription drugs and is provided through private insurance companies. Part D plans cover prescription medications that you buy at your local pharmacy or through your plan’s mail order program (there are a few exceptions when drugs are covered under Medicare Part B). Part D plans typically cost a monthly premium unless you qualify for Extra Help. Although enrollment in a Part D plan is voluntary, you could be assessed a late enrollment penalty if you choose not to enroll in one when you are first eligible.
Each Part D plan has its own list of covered drugs (called a Formulary) that also specifies how the plan categorizes each covered drug (called Tiers) which is what determines your out of pocket cost like a copay or deductible. Plans also tend to have a network of pharmacies, which is why it is extremely important to shop all the options to ensure your current medications are covered at the best possible price. Thankfully you can change your Medicare drug plan every year during the Annual Enrollment Period which occurs every October 15th through December 7th.
Medicare drug plans can be purchased as an add-on to Original Medicare (and certain Medicare Cost, MSA or PFFS plans) or can be included as part of a Medicare Advantage program.
