Medicare

Medicare Supplements

Medicare Supplement insurance, commonly referred to as “Medigap,” is a private form of medical insurance that covers the gaps left by Medicare. You can buy a Medigap policy to pay for Original Medicare deductibles, co-payments, co-insurance, and other costs.

There are 9 different types of expenses that Medicare Supplement insurance policies can cover. Each standardized Medigap plan option has a different combination of benefits. Plan F is the only plan that covers all 9 types of expenses.

All Medigap plan options cover the following 4 Medicare costs:

  • Part A hospital care co-insurance
  • Part A hospice care co-insurance or co-payment
  • Part B co-insurance or co-payment (Dr. visits)
  • First 3 pints of blood
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Senior Medical Solutions

Some plan options cover some or all of the following 5 Medicare costs:

  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Part A skilled nursing care co-insurance
  • Foreign travel emergency care

Medicare Advantage Plans

Medicare Advantage plans are an alternative way to get Medicare benefits while also getting extra coverage not provided through Original Medicare.

You cannot have a Medicare Supplement policy and a Medicare Advantage policy at the same time.

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.

You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan.

If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

  • Whether the plan charges a monthly premium.
  • Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
  • The type of health care services you need and how often you get them.
  • Whether you go to a doctor or supplier who accepts assignment (if you're in a PPO, PFFS, or MSA plan and you go out-of-network).

Medicare Prescription Drug Plans (Part D)

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.

In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:

  • Provide written notice to you at least 60 days prior to the date the change becomes effective.
  • At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change.

​Starting in December 2015, for your prescriptions to be covered by your Medicare drug plan, Medicare will make sure your prescribers are enrolled in Medicare or have an “opt-out” affidavit on file with Medicare. Contact your plan or your prescribers for more information.

Part D Plans

Payments throughout the year in a Medicare drug plan:

Your actual drug plan costs will vary depending on:

  • The drugs you use
  • The plan you choose
  • Whether you go to a pharmacy in your plan's network
  • Whether the drugs you use are on your plan's formulary
  • Whether you get Extra Help paying your Medicare Part D costs