Medicare 101
Medicare Part A
Medicare Part A provides hospital coverage that covers inpatient hospital stays, care in skilled nursing facilities, home health care, and hospice. Part A is covering the physical hospital when you spend the night inpatient.
Medicare Part B
Medicare Part B is mostly going to include outpatient services. Part B covers items such as doctors visits, outpatient surgery, outpatient X-rays, Durable medical equipment, ambulance services, and many other things. Typically what Medicare Part A does not cover Part B will cover.
What Is Not Covered By Original Medicare
Original Medicare does not cover many things and this leaves gaps in you coverage! Medicare does not cover prescription drugs, dental, vision, hearing, or a traditional physical. Do not worry! We will help you find the plan that best fits your needs.
Medicare Supplement
What is a Medicare Supplement?
Medicare Supplements are designed to pay after Medicare. In these plans, the supplement works with Medicare. If Medicare pays a claim first, the supplement will pay afterwards. The same goes if Medicare does not cover a claim, the supplement will not pay. Since Medicare does not cover things like Part-D drugs, dental, vision, and hearing, the supplement will not either. These things can be added separately by Part-D drug plans and Dental, Vision, And Hearing plans. Compared to Advantage plans Supplements are a little more expensive because there is less exposure out of pocket, and you can see any doctor who accepts Medicare.
Medicare Advantage
What is a Medicare Advantage Plan?
Medicare advantage plans are some of the most advertised plans in the insurance industry. Many of these plans offer a $0 premium, which is very enticing to anyone. The best way to explain Medicare Advantage plans is that the plan would be a package deal that provides Medicare medical coverage, prescription coverage, and extra benefits that could include dental, vision, health, over the counter benefit, gym membership, transportation, Telehealth, meals after hospitalization, etc. The person purchasing this plan assigns their Medicare to a private insurance company. When doing so, the private insurance company takes over the risk for covering that individual. When selecting a plan, you will be assigned a network of hospitals and doctors you can go to based on the plan, but going outside of this network will increase your costs! Compared to Supplements Medicare Advantage plans are likely to be less expensive because there is a set list of doctors and hospitals that are in network with a plan. These plans usually have a maximum out of pocket limit between $3,000 - $8000.
Prescription Drug Plans
Part-D
What is Medicare Part-D?
Medicare Part D is best explained as Medicare prescription drug coverage
How do I get Part-D coverage?
- You can purchase a stand-alone Part D plan or you can buy a Part D to pair with a Medicare Supplement
- You can purchase a Medicare Advantage that includes a Part D
Formulary and Tier System
Part-D plans determine their coverage by having their unique formulary (list) of medications. The formulary determines what drugs are covered and at what rate. Usually plans will have 1-5 tiers with 1 being the lowest and 5 being the highest. The higher the tier the higher the copay.
- Preferred Generics
- Generics
- Preferred Brands
- Non-preferred
- Specialty
Stages of Medicare Part-D
- Deductible Stage - You pay all cost up to the deductible. Some plans exclude certain tier drugs.
- Initial Stage - In this stage you pay a set copay or coinsurance depending on the tier the prescription is placed in.
- Coverage Gap (Donut hole) - You pay 25% of total cost of the drug. Some plans have Gap coverage.
- Catastrophic- - You pay 25% of total cost of the drug. Some plans have Gap coverage.
- These Stages reset back to stage one January 1 every year
