Medicare 101

Medigap/Medicare Supplements and Prescription Drug Plans (PDPs) Close or Narrow Most Health Coverage Gaps in Original Medicare A & B.

 

Medicare Supplement (or Medigap) plans provide insurance coverage for the "gaps" that Original Medicare Parts A & B do not cover, including deductibles. co-payments and co-insurance.

 

Choice of Doctors, No Networks, No Referrals Needed - With a Medicare Supplement plan, you can utilize any doctor / provider that accepts Medicare.  No referrals are needed as long as you utilize a doctor or provider that accepts Medicare (which is the vast majority of doctors and providers).

 

Portable Coverage, Accepted Anywhere - Medicare Supplement plans cover the entire United States and you can rely on uninterrupted coverage when you relocate to a new areas in the US or on most travel abroad.

 

 

Potentially Significant Differences Exist Between Original Medicare + Medigap Supplements + PDPs ... and ... the Privatized 'Medicare Advantage' Plans

 

Medicare Advantage Plans. an alternative privatized version of Medicare coverage where Medicare-approved insurance carriers are paid a fee by the Centers for Medicare and Medicaid Services (CMS) to provide a package of healthcare and related services following guidelines set by Medicare.  Medicare Advantage plans are often called "Part C" of Medicare (or "MA" or "Advantage" plans) and you must qualify for the Part A of Medicare and be enrolled for Part B (where you and every other Medicare user pays a monthly premium (of $164.90 per month in 2023 unless your premium is subject to Income-Related Monthly Adjustment Amount (IRMAA). 

Low Monthly Premiums - Medicare Advantage plans often are either $0 or low monthly premiums. They often offer added benefits such as RX coverage and gym benefits.

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Provider Networks May Be Limiting - In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest plan costs. These plans set a Maximum Out Of Pocket (MOOP) each year for covered services, to help protect you from unexpected costs.  The MOOP for 2023 is $8400.

 

 

Prescription Drug Plans (PDPs)

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Medicare Part D Prescription Drugs - Medicare Part D covers the cost of prescription drugs. You'll secure Part D coverage through private insurance companies (who partner with Medicare), and the formulary of prescription drugs that your plan covers will vary by provider within overall guidelines set by Medicare.

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Brand-Name and Generic- Most Part D plans provide both brand-name and generic prescription drug coverage. At a minimum, every provider must cover two options within the most common drug categories, meaning that Plan D will provide drug coverage for the majority of conditions.

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Two Ways to Access Part D - You can choose from a variety of Part D offerings from leading insurance companies that may cover the vast majority of your prescription costs each year.  A part D plan would complement your Parts A and B, and Medicare Supplement plan.  The second way to have prescription drug coverage is a Medicare Advantage plan which bundles in prescription drug coverage (an MAPD plan). Consumers should confirm any prescription drug plan offering they consider has their required or anticipated prescriptions.