Medicare
Before choosing a plan we want to be sure you know the difference between your many options; In particular how Medicare Supplements and Medicare Advantage Plans differ. Many people sign up for Advantage Plans thinking they are Supplements, they are not.
Medicare Supplement Insurance Plans
A Medicare Supplement Insurance (Medigap) policy works alongside Original Medicare. After Medicare pays its share of covered services, a Medigap policy may help pay some or all of the remaining eligible out-of-pocket costs, depending on the specific plan selected.
Individuals with Original Medicare generally may receive care from any provider that accepts Medicare patients. Before receiving services, you should confirm that your healthcare provider accepts Medicare and your Medigap coverage.
Most Medicare Supplement policies do not include outpatient prescription drug coverage. Individuals who want prescription drug coverage generally need to enroll in a separate Medicare Prescription Drug Plan, unless they have other creditable prescription drug coverage. Individuals who delay enrolling in when first eligible may be subject to a late enrollment penalty, unless they qualify for an exception.
While the standardized benefits of a Medicare Supplement plan generally remain the same for a given plan type, premiums may change over time.
Medicare Advantage
Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide Medicare-covered benefits. When you enroll in a Medicare Advantage plan, you continue to participate in the Medicare program, but you receive your Medicare-covered benefits through your plan rather than through Original Medicare.
Many Medicare Advantage plans use provider networks, such as HMOs or PPOs. Before enrolling, it is important to verify whether your preferred physicians, hospitals, pharmacies, and other healthcare providers participate in the plan's network. Using out-of-network providers may result in higher out-of-pocket costs or, depending on the plan, services may not be covered.
Most Medicare Advantage plans include copayments, coinsurance, deductibles, or other cost-sharing requirements. These costs vary by plan and should be reviewed carefully before enrollment.
Many Medicare Advantage plans include Medicare prescription drug coverage (MA-PD plans), although not all plans do. If you later choose to return to Original Medicare and enroll in a Medicare Supplement policy, you may also need to enroll in a separate Prescription Drug Plan if prescription drug coverage is not otherwise available.
Some Medicare Advantage plans offer additional benefits beyond Original Medicare, such as dental, vision, hearing, fitness, or wellness programs. These benefits vary by plan, carrier, and service area and may change from year to year.
Medicare Prescription Drug Coverage
Medicare Prescription Drug Coverage
Medicare offers prescription drug coverage through private insurance companies approved by Medicare. Coverage options, premiums, deductibles, copayments, and formularies vary by plan.
If you do not enroll in a Medicare plan when you are first eligible, and you do not have other creditable prescription drug coverage or qualify for Extra Help or another exception, you may be required to pay a late enrollment penalty if you enroll at a later date.
Two Ways to Receive Medicare Prescription Drug Coverage
1. Medicare Prescription Drug Plan
A stand-alone Medicare Prescription Drug Plan (PDP) can be added to Original Medicare and certain other Medicare health plans that do not already include prescription drug coverage.
2. Medicare Advantage Plan with Prescription Drug Coverage (MA-PD)
Many Medicare Advantage plans include Medicare prescription drug coverage. These plans provide Medicare and prescription drug coverage through a single plan. You must be enrolled in Medicare to enroll in a Medicare Advantage plan.
What Drug Plans Cover
Each Medicare plan has its own list of covered prescription drugs, known as a formulary. Covered medications, pharmacy networks, premiums, deductibles, copayments, and coinsurance vary by plan.
Many plans place medications into different pricing tiers. In general, medications in lower tiers may have lower out-of-pocket costs than medications in higher tiers.
If a prescribed medication is placed in a higher-cost tier, you or your healthcare provider may be able to request a formulary exception if the plan's requirements are met.
Because Medicare Advantage plans may change each year—and because plan availability, provider networks, and premiums vary by county—it is important to review your coverage annually during the Medicare Open Enrollment Period.
If you have questions about your Medicare options, a licensed insurance agent can provide information about available plans in your area and help you compare coverage, costs, and provider networks so you can make an informed decision.
