It’s time to start looking at your health plan options. 

Medicare is a federal government program that provides health care coverage if you are 65 years or older, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget.

Once you have become Medicare-eligible and enroll, you can choose to get your Medicare benefits from Original Medicare, the traditional fee-for-service program offered directly through the federal government, or from a Medicare Advantage Plan (Medicare Part C), a type of private insurance offered by companies that contract with Medicare (the federal government).

Original Medicare includes:

• Part A – Inpatient & Hospital coverage
• Part B – Outpatient & Medical coverage

If you want Medicare prescription drug coverage or Medicare Part D, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan.

Every day we face the situation and have found three important factors to consider when comparing an employer plan to Medicare insurance. Keep in mind that in many cases, employer insurance will become much more expensive when you turn 65. For more detailed information regarding your employer insurance, you should consult with your Human Resources department.

Factors to Review when Comparing Employer Coverage vs. Medicare:

1. Basic plan information: premiums, deductibles, copays, coinsurance, etc.
2. Additional coverage options such as dental, vision, and hearing
3. Dependent coverage: How will your dependent’s coverage change if you leave the employer options, and how could they be covered by insurance through Healthcare.gov

Medicare Supplement Insurance, also known as a Medigap Policy, helps you pay the remaining 20% of the costs left behind by Original Medicare. With a Medicare Supplement insurance plan, you have Original Medicare and a Medigap policy. Medigap policies are organized by the letters of the alphabet. Each plan letter covers different pieces of the gaps left behind by Original Medicare. The more important thing to know about Medicare Supplement plans is that they are standardized by the federal government. No matter which insurance company sells a Plan G, the benefits are always the same. The only difference between plans from company to another is the monthly premium. This is the same for every plan letter no matter where you are in the country. Plan G with Company #1 is the exact coverage as Plan G with Company #2 and #3; however, their premiums can be different.

Medicare Part D is prescription drug coverage. No matter if you take one prescription, or twenty, there is a Part D plan designed to meet your needs. To enroll in Medicare Part D, you must choose a Part D plan that works best. You can review plan options at the official Medicare website, or you can contact your Medicare Pathways benefit advisor for additional assistance. Medicare Part D is a Medicare program designed to assist the costs of prescription drugs and prescription drug premiums. It was introduced in 2003, as part of the Medicare Modernization Act and was officially available to Medicare beneficiaries in 2006. Medicare Part D prescription drug plans cover their own set of drugs. The list of drugs that a plan covers is called a formulary. The cost of drug plans varies based on which types of drugs you need and whether you participate in your plan’s network pharmacy. There is also no standard monthly premium for Part D plans.

Medicare Part C, also known as Medicare Advantage, is another coverage option you can select. These plans are offered by private insurance companies and are approved by Medicare to take over your Original Medicare Part A and Part B basic benefits. These plans all have a network (e.g., PPO, HMO, and PFFS) and can change their network and coverage from year to year. Medicare Advantage plans also offers additional benefits within their plan, sometimes including prescription drug coverage.

Do you feel like you have more questions regarding your Medicare options?

We can help discuss Medicare basics, plan options, and help you understand more of the core concepts on how you can choose to receive your Medicare benefits. Here are the core concepts to review and keep in mind:
 

• Medicare Part A is hospital insurance
• Medicare Part B is medical insurance
• Original Medicare is Medicare Part A & Part B
• Medicare Part C is Medicare Advantage Plans
• Medicare Part D is prescription drug insurance
• Medicare Supplement insurance plans fill in the gaps left behind by Original Medicare
• Medicare Supplement insurance plans are often called Medigap policies

Give us a call to learn more about all of your options at 833-897-8965.