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Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C plans, are health insurance places that are approved by Medicare and run by private insurance agencies. Medicare Advantage plans are required to provide all the same benefits as Medicare Part A and Part B and may include prescription drug coverage. These plans add additional coverage, including vision, dental, medical transportation, health club memberships, and hearing aid coverage. There are many different types of Medicare Advantage plans. We can help you select the best plan for your needs.
What To Know About Medicare Advantage Plans
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You must have Medicare Part A and Part B to enroll in a Medicare Advantage plan.
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All Medicare Advantage plans MUST include a limit on your out-of-pocket expenses for Part A and Part B services, which can be costly. These plans can't include copays or coinsurances that are higher than they would be normally under original Medicare for certain services, but other services may be higher.
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Medicare Advantage plans can provide additional benefits including hearing aids, vision, dental and medical transportation.
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You still have Medicare if you enroll in a Medicare Advantage plan, and you must still pay your monthly Part A and Part B premium, if you have one. Each Medicare Advantage plan must provide all Part A and Part B services, but it can do so with different rules, costs, and restrictions than original Medicare plans.
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Medicare Advantage plans generally charge a premium in addition to the Part B premium. Most also charge a copayment that you are required to pay at the time of service. Some plans also charge a coinsurance for some or all services.
Medicare Supplement Insurance
Both Medicare Part A and B may not cover all the expenses you need when seeking medical care. Medicare Supplement insurance, also known as Medigap, covers some of these otherwise uncovered expenses. Medigap insurance helps to fill the "gap" left by Medicare. Medicare supplement isn't designed to replace Medicare, but it supplements Medicare by covering copayments, deductibles, coinsurance, and more. These plans are standardized by the same agency that oversees Medicare but are sold by private insurance companies.
What To Know About Medicare Supplement Insurance
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Medigap policies typically don't cover long-term care, vision, dental, hearing aids, eyeglasses, or private nursing.
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Medigap only covers one individual. You and your spouse will have to purchase separate Medigap policies.
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Medigap policies don't cover prescription drugs. You will need prescription drug coverage, and you can join Medicare Prescription Drug Plan (Part D).
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You must have Medicare Part A and Part B. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but ensure you have a valid disenrollment from the Medicare Advantage Plan before your Medigap policy begins.
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You pay your private insurance company for the Medigap policy in addition to what you pay Medicare for your monthly premium.
Medicare Part D Prescription Drug Plans
Medicare Part D adds prescription drug coverage to Medicare or Medicare Advantage plans. Prescription drug plans are offered by private insurance companies that are approved by Medicare. Each plan can vary in cost and drugs covered. HCM Holdings can help you navigate these drug coverage plans and decide which one is best for you.
The 4 Types of Medicare
Part D
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You will pay the full cost of your prescriptions until they add up to meet your plan's deductible. Some plans have a $0 deductible
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After spending $7,400 out of pocket on drugs, you receive catastrophic coverage. You will pay a low coinsurance or copayment amount that is set by Medicare for all of your covered prescription drugs. The plan and the government will pay for about 95% of the cost. This stage lasts until the end of the year.
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This begins once you meet your deductible for the year. Your plan will pay for a portion of the prescription drugs as long as it is covered by your plan's formulary, or list of covered drugs. You are responsible for paying the other portion, which is either a set dollar amount, or copayment, or percentage of the cost, or coinsurance. This ends once you and your plan spend on covered drugs adds up to the initial coverage limit set by Medicare. Your Monthly premiums do not count toward this limit.
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This begins once you and your plan reach your initial coverage limit for the year. Not everyone reaches this stage. If you do not enter this stage, you will pay 25% of the plan's cost for brand name drugs and 25% of the cost for generic drugs until your out of pocket costs on drugs reaches $7,400.
Annual Deductible
Initial Coverage
Coverage Gap
Catastrophic Coverage
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