A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account plans. Medicare Advantage Plans must offer at minimum all the benefits offered through Original Medicare but typically exceed these minimum standards. You must be enrolled in Original Medicare (Part A & B) to order to join a Medicare Advantage plan. Most Medicare Advantage Plans offer prescription drug coverage and are zip code specific. For an updated list of plans in your specific area you can visit www.Medicare.gov and perform a search…. Or Contact Us! and we’ll gladly do the research for you. Providing a non-bias comparison of the benefits that matter most to you.
Medicare Supplement Insurance Plan (Medigap)
Medicare supplement (Medigap) insurance plans are sold by private companies and can help pay some of the health care costs that Original Medicare doesn't cover like; copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare approved amount for covered health care costs. Then your Medigap policy pays its share, that amount is specific to the particular plan you choose.
Medigap or Medicare Supplement plans are not the same as a Medicare Advantage plans.
8 Things to Know about Medigap Policies :
1) You must have Medicare Part A and Part B to enroll.
2) If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
3) You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
4) A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
5) You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
6) Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
7) Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (PDP).
Medigap Policies Don't Cover Everything
Medigap policies generally don't cover long term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Medigap Policies are Standardized
Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:
• Don't have to offer every Medigap plan
• Must offer Medigap Plan A, and C or F if they offer any Medigap policy
Compare Medigap Plans Side-by-Side
The chart below shows basic information about the different benefits Medigap policies cover.
Yes = the plan covers 100% of this benefit
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable
* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,110 (in 2013) before your Medigap plan pays anything. ** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.
Compare the Costs of Medigap Plans
Insurance companies may charge different premiums for the same exact policy. As you shop for a policy be sure you're comparing the same policy (for example, compare Plan A from one company with Plan A from another company). There are a large variety of insurance companies you can shop that currently offer Medigap insurance and each one with its own special perks and rates for the exact same plans. You can research each one individually…
Comparing costs is our specialty! Contact Us today and let MedicareLA do the work for you. We can provide non bias, no cost, evaluations specifically tailored to your individual situation.
Prescription Drug Plan (PDP)
Prescription Drug Plans or PDP’s add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, Medicare Medical Savings Account Plans, and Medicare Supplement Plans (Medigap). These plans are offered by private insurance companies and approved by Medicare. Medicare Advantage plans may include prescription drug coverage that follows the same rules as standalone Medicare Prescription Drug plans. Medicare beneficiaries must have ‘qualifying’ drug coverage or may be subject to a Late Enrollment Penalty.
Late Enrollment Penalty:
The late enrollment penalty is an amount added to your Medicare Part D premium. You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage. The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage. The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" times the number of full, uncovered months you were eligible but didn't join a Medicare Prescription Drug Plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.
There are 2 ways to get a Prescription Drug Plan:
1) Adding a stand-alone plan.
2) Enrolling in a Medicare Advantage Plan that includes prescription coverage. Medicare Advantage Plans that include prescription coverage are sometimes called MA-PD’s.
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.
General Cost Overview:
Monthly premiums, deductibles, and copays vary widely in different areas and change years.
We highly recommend you consult www.Medicare.gov
or one of our licensed specialists for
the latest updates.
Extra Help (LIS):
Extra Help or Low Income Subsidy is the government prescription assistance program for Medicare beneficiaries. Those with limited resources and income can get help with prescription premiums, deductibles, and copays. Extra Help is estimated to be worth about $4,000 per year in savings. Not everyone will qualify but all are encourage to apply. Online: www.SocialSecurity.gov/extrahelp
Phone: 800-772-1213 TTY 800-325-0778
In Person: Your Local Social Security Office
Prescription coverage is an important but confusing part of what makes a Medicare plan right for you. To find the right one you can consult www.Medicare.gov for a list of available plans in your area.
Contact Us, we would love to assist in finding the right fit for you!