Navigating your Options
When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people need to get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). We can help you understand your options and assist as you decide what coverage best meets your needs.
Medicare Advantage is also referred to as Medicare Part C. Medicare Advantage plans are administered by private insurance companies contracted with Medicare. They cover everything that Original Medicare does and may include extra benefits as well, like prescription drugs, dental, vision, hearing and fitness memberships. Not all of these plans cover the same extra benefits. These plans typically have lower out-of-pocket costs than Original Medicare and have an annual cap on out-of-pocket costs, which Original Medicare does not have. Medicare Advantage plans have provider networks and covered drug lists. Before enrolling into a plan, research the benefits and be sure that your doctors and medications are covered.
Medicare supplement insurance, or Medigap, is an additional health insurance policy you can buy from a private insurer to help pay some of the costs not covered by Original Medicare, including deductibles, coinsurance and health care if you travel outside the U.S. Medigap plans don’t cover long-term care, prescription drugs, dental, vision, hearing aids or private nursing care. There are 10 types of Medigap plans available in most states. Plan F and Plan G are the 2 most comprehensive and the most popular. Premiums depend on gender, ZIP code and tobacco use and for Plan F can range from around $120 per month to over $400. You must have Original Medicare to purchase a Medigap policy. Medigap is not compatible with Medicare Advantage — you would purchase one or the other.
Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. Plans are offered by private insurers and require a monthly premium that averages about $35 a month. Higher income beneficiaries pay more. As with Medicare Part B, there typically is a late enrollment penalty added to the premium if you don’t sign up when you are first eligible.
Before enrolling into a plan, make sure your medications are covered in the drug formulary. A drug formulary is a list of drugs covered by a Part D plan. Most Part D plans separate the medications they cover into four or five drug formulary tiers. The cost of the medication will depend on the drug tier that is associated with the medication.