Part A (Hospital Insurance):
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Part B (Medical Insurance):
Helps cover: Services from doctors and other health care providers. Outpatient care. Home health care. Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment). Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
is an alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "bundled" plans include Medicare Part A (Hospital) and Medicare Part B (Medical), and usually Part D (Drug Coverage).
Part D (Drug coverage):
Medicare requires you to have and retain Prescription Drug coverage, and will add a penalty if you go without coverage. Most join a Medicare drug plan in addition to Original Medicare, or join a Medicare Advantage Plan with Drug coverage.
Before choosing a plan we want to be sure you know the difference between your many options, and how each choice affects your health care, your coverage, and your retirement income.
In particular it is important to know how Medicare Supplement Insurance Plans and Medicare Advantage Plans differ in coverage’s, costs, and price changes over time.
Many people sign up for Medicare Advantage Plans thinking they are Medicare Supplement Insurance Plans, which they are not. Many people assume they can always change Coverage Plans, which they can not always do. Many people assume the “Medicare rules” for each coverage option are the same, again, they are not. Many people also are not aware of all of the options they have to make changes.
My purpose is to be a resource, to know and use all of the rules and quirks to serve your needs, and help you enjoy a frustration free coverage experience.
A Medicare Supplement Insurance Plan is used with original Medicare. Any caregiver that accepts Medicare will take a Medicare Supplement Insurance Plan because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Medicare Supplement Insurance Plans do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement Insurance Plan does not change year to year (although the cost does generally go up the coverage does not change).
Providers add coverage beyond what Medicare provides: All cap on out of pocket medical costs, Some rebate part B premiums, lower cost shares for services, add Part D, dental, vision and hearing services, transportation assistance, post release meal services. Talk to John to see what is in your area.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
Medicare Prescription Drug Plan (Part D) (sometimes called "PDPs") helps cover the cost of prescription drugs. Medicare requires you to have and retain Prescription Drug coverage, and will add a penalty if you go without coverage. Most join a Medicare drug plan in addition to Original Medicare, or join a Medicare Advantage Plan with Drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare. Those who served may have acceptable coverage from the VA.
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.