Part A of Medicare covers In-Patient expenses such as hospital and skilled nursing facilities. Part A has no premium as long as you have paid sufficiently into social security and medicare. You may be able to purchase Part A benefits if you don’t have enough credits to qualify for Part A.
Part B of Medicare covers Outpatient expenses such as doctors visits, lab tests, x-rays, & diagnostics. Part B has a base premium of $121.80 per month. If your income is over $85k Single or $170k Joint, your Part B premium will be higher. If you are receiving social security, this premium is deducted from your social security check. If you are not receiving social security, you will receive a quarterly bill which you pay to Medicare. Due to a hold harmless provision, people who were on Part B prior to 2016 and had their premium deducted from Social Security will still pay $104.90/month.
Medicare was designed to help seniors keep medical cost affordable but was never designed to pay 100% of medical expenses. As a result, those on Medicare are responsible for out of pocket expenses. Due to the out of pocket exposure, most people buy additional coverage to protect against these costs.
There are 2 Types of Medicare Plans to help cover out of pocket expenses; Medicare Supplement Plans & Medicare Advantage Plans
Medicare Supplement/Medigap Plans
These plans are standardized and recognized by the letters A through N. Supplement Plans work with traditional Medicare and pay expenses Medicare does not pay.
Plan “F” is the most comprehensive plan providing the most protection.
Plan “G” is less expensive than “F” but you pay the part B deductible.
Plan “N” is a low cost plan option that has limited out of pocket exposure.
Current Medicare Supplement plans do not provide Part D Rx coverage
You will need to buy a stand alone Rx plan to obtain prescription drug protection. Some Supplement plans include an exercise membership like Silver Sneakers.
Medicare Advantage Plans
These plans are network based plans typically either an HMO or PPO. Advantage plans have co-pays for most medical services. These plans have an annual out of pocket maximum that caps the amount you can pay out of pocket. Most Advantage plans include your Part D Rx coverage in the plan. An Advantage plan replaces your traditional Medicare coverage and becomes your primary payer. These plans usually include basic vision, dental, & hearing benefits plus an exercise membership. Medicare Advantage Plans are generally less expensive than Supplements but have more of pocket risk. Advantage Plans are referred to as Part C of Medicare and generally combine Parts A & B with Part D.
Part D Rx Plans
Medicare does not provide prescription drug coverage to you directly. You obtain Rx coverage by purchasing a Part D plan through an authorized Part D Company. All Part D plans use a formulary which indicates the drugs covered by the plan. Drugs are placed into tiers or level with different co-pays associated with each tier. Part D plans follow the same basic format with 3 phases or levels; Initial – Coverage Gap – Catastrophic
Initial Coverage Phase: You have up to $3,310 (2016) of Rx benefits based on the total cost of the drug.
Coverage Gap (Donut Hole): You pay for your drug costs out of pocket but at discounted rates.
Catastrophic Level: If you pay $4,850 (2016) in out of pocket costs you get Rx coverage again at better co-pays.
We offer Supplement, Advantage, and Part D plans with the most competitive insurance companies in our area. We assess your current situation and compare plans to make sure your doctors, specialists, hospitals, and prescription drugs are covered.