Original Medicare has two Parts, Part A and Part B. Part A provides coverage for services like In Patient Hospitalization, Skilled Nursing, Hospice, as well other services. Part B Medicare provides coverage for most other services like Physician Visits, Outpatient Procedures, Lab Work, X-Rays, Physical Therapy, Medical Equipment, as well as other services. There are Deductibles for Part A and Part B of Medicare that the insured will be billed as well as Co Insurance amounts not covered under Medicare Part B. In general, Medicare Part B pays 80% of approved Charges and the insured will be responsible for the other 20%. These gaps in coverage make it an important consideration to look at adding a Medicare Supplement Policy, also called a Medigap Policy, to fill in the coverage gap between the total amount of the treatment and what Medicare Part A and Part B does NOT cover. Medicare Supplements are identified by letters and some of the most popular are the Plan F, Plan G, and Plan N Medicare Supplement. Each of these 3 provide differing levels of protection, but all 3 offer a great deal less risk exposure versus just have only Original Medicare.

What is a Medicare Advantage Plan?

Medicare Advantage Plans are called Part C Plans and refer to Medical and available Prescription Coverage in 1 policy. Theses do NOT coordinate with Medicare like Medicare Supplements and pay INSTEAD of Medicare. Even though you are still in Medicare and paying your premium for Part B of Medicare, you ONLY use your Medicare Advantage Plan ID Card and the point of receiving Medical Care or filling Prescriptions. Private Insurance Companies offer these Medicare Advantage Plans then the premiums are very affordable and some Carriers offer premiums at $0 planned premium per month. The thing to watch for is what you will have to pay for each Medical Treatment you receive. These plans bill the insured’s a copay for each treatment and some services are billed to the insured as a coinsurance amount—for instance billing the insured 20% of the allowable charges. Medicare Advantage Plans have what is called an Out of Pocket Maximum to each Policy which is simply the limit in the total amount of copays or coinsurance amounts the insured can be billed in a calendar year. Many plans have Out of Pocket Limits close to $6000 per person per year with Carriers offering Policy with lower and higher Out of Pocket Limits to insureds. It is important to remember that if you purchase a Medicare Advantage Plan and develop a pre existing health condition that you may not be able to Medically Qualify to move to a Medicare Supplement that offers greater coverage for a greater premium.

What is a Part D Rx Plan?

Part D Plans refer to stand alone prescription drug policies that only pay for prescribed medications. These plans are offered by Insurance Companies and regulated by CMS—The Center for Medicare Services. Typically, you pay a monthly premium for these Part D Rx Plans and then you have a copy or coinsurance amount to pay for you medicine from the Pharmacy. Some plans have deductibles to meet before you can get your medications for a copay or coinsurance amount. There are search engine tools online that we use to determine which plan covers your prescribed medications at the lowest overall cost per year.

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