Medicare Coverage Options “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”
Understanding the different coverages
There is no charge to discuss your specific situation, our agency is paid a commission if you decide to enroll through us. However, we do not pressure. We are independent agents representing many carriers in Georgia and South Carolina, your needs determine the plan/carrier.
Original Medicare:
Coverage is clearly explained in the Medicare and You Handbook a copy is in our resources tab. This handbook is updated around October of each year. If you do not receive a paper copy, you can call to request it, or go on line to the Medicare.gov web site and download a copy. The following summary is simply a highlight of the many benefits offered the Medicare Beneficiary.
Medicare Part A- Hospital, Skilled Nursing Facility Care, blood, Hospice Care
Part B- Medical expenses in or out of the hospital and outpatient treatment such as Physician services, in and outpatient medical and surgical services and supplies, limited number of drugs like injections you get in a doctor’s office, certain oral cancer drugs, drugs used in some types of durable medical equipment, physical and speech therapy, diagnostic tests, durable medical equipment, blood, clinical lab services, Home health care.
Part D Drug coverage:
These plans add drug coverage to Original Medicare. You must have Medicare Part A and/or B to join a plan. Each plan has a formulary (definition in terms). The same plans are offered throughout a specific state. Plan premiums, copays, exceptions (quantity limits, prior authorization, step therapy), formulary, deductible vary with each carrier. Carriers may offer multiple plans in a state. Additionally, these plans have a one-year contract with Centers of Medicare and Medicaid (CMS) so plan changes can occur each year.
Consider: The Medicare web site has a Medicare Plan Finder to assist in comparing the numerous plans offered in a state. Cost can be affected by the pharmacy you use, and whether or not you use mail order. The same medicine may not have the same copay with all carriers, so it truly benefits to compare coverages.
We offer a one- time free assistance to any caller in GA or SC, and conduct annual reviews for our clients each year at no charge.
Medigap or Medicare Supplement Plans:
This is additional health insurance you purchase through a private insurance company. Ponder on these thoughts: By law the benefits offered for each Medicare Supplement plan is exactly the same. The only difference is premium and some carriers may offer value added services such as a nurse hot line, vision services discounts, etc. Premiums can vary by: age, gender, tobacco usage, area of the state where you live, plan selected, and health condition. You can enroll in this coverage anytime of the year but note: these plans DO NOT work with a Part C Medicare Advantage plan (to be discussed next), if you do not have a qualifying event giving you a guaranteed issue situation you must be able to answer NO to specific carrier questions to purchase the policy.
Call us to discuss your specific situation
Personal observations: Premiums typically bump up each year and depending on the carriers’ rate system you may have an additional bump in premium due to aging each year or at a specific age.
Due to rate variations in counties and different underwriting criteria we represent multiple Medicare Supplement carriers in an effort to find the lowest premium in your county.
Medicare Part C, Medicare Advantage plans
Most Medicare beneficiaries can elect to have their Medicare health coverage through a private carrier. Consider some basic facts about these plans:
A. you must apply and Medicare approve you to have this coverage
B. plans and benefits may vary by county/state
C. carriers have a one year contract with Medicare so typically plan benefits/premiums can change annually
D. they must offer the same coverage offered you by Medicare but may have different copay, coinsurance, require you to use a specific network of providers
E. when you elect Part C coverage you remain a Medicare beneficiary but as long as you have the Part C plan, Medicare does NOT pay any portion of your claims only the carrier
F. you are able to change plans each year
G. these plans are not supplement coverage
H. many have no or low additional monthly premiums
Medicare Savings Account (MSA)
GA and SC will now have a Medical Savings Account Part C Medicare Advantage plan. You have an annual deposit of $2000 or $3000 deposit into a MSA account. You use these funds to pay for any Part A & B medical benefits received. IF you use all of the funds you will have a deductible to meet before the plan pays. If you have a portion of those funds left over at end of the year, it “rolls over” for use next year.
Use this link to learn more https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-medical-savings-account-msa-plans
Personal Observations:
1. Plans typically offer you benefits Original Medicare does not offer. These vary by carrier and no one carrier offers all these, but here are a few examples: drug coverage, an annual maximum out of pocket, routine vision and/or dental, over the counter medicines, gym memberships, hearing aids, personal emergency response system equippment and monitoring.
2. You will want to understand any network restrictions/requirements. Network requirements may mean you pay a greater amount if you do not use their network providers.
3. Part C Plans which include drug coverage will use a formulary. Ensure you understand what is covered and your copays.
We represent multiple carriers throughout the states of Georgia and South Carolina.
TERMS
Coinsurance—An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Copayment—An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
Creditable prescription drug coverage—Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty if they decide to enroll in Medicare prescription drug coverage later.
Deductible—The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
Formulary—A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. This is also called a drug list.
Extra Help—A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.