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Medicare Health Plan Options
Medicare Supplement Insurance Plans
Helps fill in the gaps left behind by Original Medicare
Most popular Medicare Supplement Plan Types include Plan G, Plan F, and Plan N
All plans are standardized and usually have very small out-of-pocket costs
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A Medicare Supplement or Medigap, is a private plan offered by insurance companies and helps to pay for most of your out-of-pocket costs like copays, deductibles, and premiums. This plan picks up where Original Medicare stops. Medicare Supplements are standardized plans in 47 states, while three states – Massachusetts, Minnesota, and Wisconsin have their own customized plans. The standardized Medigap plans are marked by letters of the alphabet – A, B, C, D, F, G, K, L, M, and N. Once enrolled in a Medicare Supplement, your plan will cover the portion of your bill, once Original Medicare has paid its claims. Medicare Supplements do not cover prescription drugs plans. Medicare Supplements can only be used with Original Medicare Part A & Part B.
Medicare Advantage Insurance Plans
Offers the same benefits as Original Medicare Part A & Part B
Variety of plan options including HMO/PPO networks, and $0 premium special needs plans
Most plans include Medicare Part D Prescription Drug coverage
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Medicare Advantage is another name for Medicare Part C and provides the same benefits as Original Medicare Part A & Part B, with the exception of hospice care, a service covered by Part A. Medicare Advantage plan members will continue paying their Part B premium in addition to the monthly premium set by the private insurance company. Many Medicare Advantage plans offer Part D, which covers prescription drugs. This plan offers doctor visits, hospital stays, and other health care providers within a network. Medicare Advantage plans also usually require co-pays and deductibles. Unlike Original Medicare Part A & Part B, these payments put annual limits on how much you pay out-of-pocket. Once you’ve reached the set limit, the plan will cover your medical expenses for the rest of the year. This means you won’t have to pay any more after reaching the spending limit. Medicare Advantage plans often include additional benefits such as transportation, gym memberships, dental, vision, and hearing coverage and more.
Medicare Part D Prescription Drug Plans
Covers costs of prescription drugs
Stand-alone plans offered by private insurance companies
Every plan includes deductibles, premiums, copays, and coinsurance
More Details
Medicare Part D encompasses a variety of drug plans. These plans cover its own set of drugs listed on a formulary. The cost of drug plans varies based on which types of drugs you need and whether you participate in the plan’s network pharmacy. There is also no standard monthly premium for Part D, as it varies by the private insurance company which sets premiums each year. The stand-alone Medicare Part D plans provide drug coverage only and are used by beneficiaries that come from the Original Medicare program. These plans can be used with Medicare Supplements. Most individuals enrolled in Medicare Advantage plans already have existing prescription drug coverage within their plan. Medicare Part D has a coverage gap that strongly affects out-of-pocket prescription drug costs, this is known as the Part D donut hole. The donut hole puts a restriction on how much your Part D plan will pay for covered drugs. Beneficiaries in the donut hole pay higher percentages for both brand name and generic drugs.
Are You New to Medicare?
Are you researching Medicare because it’s your first time signing up?
It’s easy to get confused. There are so many parts. How do you know what plans you need? We are here to help.
We’ve got you covered with the most competitive plan options available in your market
We represent only the top-rated insurance companies. We handle all types of personal insurance needs, but we specialized in everything Medicare.
Understanding the Basics
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.
Comparing Employer Insurance with Medicare
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:
- Basic plan information: premiums, deductibles, copays, coinsurance, etc.
- Additional coverage options such as dental, vision, and hearing
- 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
What are my Medicare options?
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.
What else do I need to know?
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.
I just want to let you know how much I appreciate Ms. Sandra Hall. She is such a lovely and helpful lady! Trying to make cost-effective and medically sound choices on a limited income can be a real challenge for senior citizens who rely on Social Security. Again I wish to thank Ms. Hall for looking out for me and my needs – we need more people like her!
Andy took the time to help me understand the differences in plan types. I had no idea I had so many options. Andy was patient with me and took time to compare all of Medicare Supplements and helped to make sure my budget wouldn’t be affected by a new plan.
I’m extremely satisfied with the customer support I receive from Medicare Pathways. They have gone above and beyond to help me with claims issues I encountered with my old health plan, then helped me find new insurance that was more affordable and helped cover more services.
Ask about your dental, vision, and hearing plan options.