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What is Medicare Supplement (Medigap) Insurance?

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

What you need to know about Medicare Supplement policies

  1. You must have Medicare Part A and Part B.
  2. If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
  3. You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  5. You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
  6. Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy as long as you pay the premium.
  7. Medicare Supplement insurance policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.

Information obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.

  • Prepare for the unexpected
  • Access preventive care services – like checkups, which are covered at 100%

Medicare Advantage Plans

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans”, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

  • Medicare Health Maintenance Organization (HMOs)
  • Preferred Provider Organizations (PPO)
  • Private Fee-for-Service Plans
  • Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2020, the standard Part B premium amount is $144.60 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount, $135 on average in 2019.

When Can I Enroll?

Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

  • For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
  • If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.
  • You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.

This information obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.

Part D Prescription Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday.

It’s important to do this on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.

Let us help you with your enrollment

If you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.

What Medicare Part D drug plans cover

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDs. Information about a plan’s list of covered drugs (called a “formulary”) isn’t included in this handbook because each plan has its own formulary. Many Medicare drug plans and Medicare health plans with drug coverage place drugs into different levels called “tiers” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

Your actual drug coverage costs will vary depending on:

  • Your prescriptions and whether they’re on your plan’s list of covered drugs (formulary).
  • What “tier” the drug is in.
  • Which drug benefit phase you’re in (like whether you’ve met your deductible, or if you’re in the catastrophic coverage phase).
  • Which pharmacy you use (whether it offers preferred or standard cost sharing, is out of network , or is mail order). Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less.
  • Whether you get Extra Help paying your drug coverage costs.

Note: Starting January 1, 2021, if you take insulin, you may be able to get Medicare drug coverage that offers savings on your insulin. You could pay no more than $35 for a 30-day supply. Find a plan that offers this savings on insulin in your state. You can join during Open Enrollment (October 15 – December 7, 2020).

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs.

  • Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. There’s a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year

Call us to help you understand your options.

Getting financial help

Individuals with annual incomes of less than $18,210 and financial resources of less than $14,100, or married couples with incomes of less than $28,150, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.

Download Medicare’s instructions on applying for the Extra Help program.

This information was obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.