We’re here to help explain how Medicare Plans differ and guide you on comparing plans through plan benefits, types, costs and ratings. Don’t let something as important as your Medicare coverage become an even more confusing and burdensome decision. Call the trusted name in the insurance industry for a comprehensive and personalized approach to understanding plan details, benefits, costs and ratings in order to meet your exact needs. Our licensed experts will provide you the best plan benefits with top rated Medicare Supplement and Medicare Advantage insurance carriers, consult with you on your healthcare needs and budget, answer your questions, and assist you with selecting the best coverage ultimately providing you peace of mind in navigating the difficult world of the insurance industry.
What is Medicare?
Medicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
- Original Medicare (A & B) covers about 80% of your medical costs. The other 20% is your responsibility. There is no cap to what you pay if you only have Medicare A&B
- A Medicare Supplement plan fills in the gaps left behind by Original Medicare (A&B), reducing your out of pocket costs
- Also called “Gap plans”, or “Med Supps”
- Does not include Prescription Drug Coverage
- No networks. You can see any doctor who accepts Medicare assignment
- Combines Medicare Parts A & B, and fills in the gaps left behind.
- Managed by private insurance companies
- You will have copays/coinsurance costs when you seek services, as well as an Out of Pocket Maximum
- Most also include Prescription Drugs (Part D), however, the costs you pay for the prescriptions do not count towards your medical plan’s OOP maximum
- Low monthly premiums
- Networks apply. You may be required to have a PCP and get referrals for specialists
Prescription Drug Coverage (also called “Part D”)
- You pay 100% of costs until you hit your plan deductible
Initial Coverage Period
- After deductible is met
- You pay a copay or coinsurance
- When your total drug costs reach $3,820 you move to the next stage
Coverage Gap (Donut Hole)
- You pay 25% coinsurance (brand) or 37% (generic)
- When your out of pocket costs reach $5,100 you move to the next stage
- You pay a small copay or coinsurance amount
- You stay in this stage for the rest of the plan year
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Part D: Prescription Drugs
Total Drug Costs – the total amount of the drug, including the portion that your plan pays.
Out Of Pocket Costs – the total amount YOU pay, does not include the portion that your plan pays. Does include your portion of the Total Drug Cost.
This information is intended to give you a general idea of the costs you will incur with Medicare. It is not an exhaustive list, your actual costs may vary.