Medicare

How do I know if I need a Medicare Advantage Plan or a Supplement?

Posted on by McGriff Williams in Medicare |

Medicare can be confusing. We can all agree on that. But it doesn’t have to be. What it really boils down to is that your options are limited, which makes things quite simple. You can go one of two routes. The first is an Advantage Plan and the second is a Supplement, or what some people may refer to as Medigap. Let us break these down to hopefully help you decide which is the best fit for you and your health care needs.
Keep in mind that this is after you’ve already enrolled in original Medicare Parts A and B, which provides the basic hospital and physician coverage. See our video here for instructions on enrolling in Parts A and B: How to enroll in Medicare parts A and B. That must be done first, and then you can essentially buy upwhichever other coverage you’d like.

– Route 1: Medicare Advantage Plan
Think of this option as a replacement policy for A and B. It essentially takes the place of your original coverage and is used just like an individual under 65 health plan would be. Most times, there are copays or coinsurance for services, a deductible to meet and an out of pocket maximum. This plan will have out of pocket expenses but the monthly premium is typically very low, considering. With this plan, you would use this card at the doctor in place of the original Medicare ID card. Advantage Plans and their provider networks can vary by county so it’s always safe to confirm that your physicians are part of the network.

Example of coverage: The current Florida Blue Medicare Advantage Plan for 2020 has a monthly premium of $47.90. Pretty inexpensive, right? There is coverage such as a $10 copay for an in-network family physician, $45 copay for a specialist, $50 copay for urgent care, $90 copay for ER visit, $295/day for inpatient hospital care, and a $6,500 out of pocket maximum. This plan also has prescription drug coverage built in at different tiers depending on the medication.

Ideal client for this plan: Someone that may not visit the doctor often, has no major health concerns or current struggles, has the financial ability to pay the out of pocket maximum in the event something big happens unexpectedly.

– Route 2: Medicare Supplement (Medigap)
A supplement is in addition to original parts A and B. It fills in the blanks of what A and B don’t cover. Now because of that, it will only cover things that Medicare does because it basically follows suit with Medicare and then supplements the gaps afterwards. This plan does not have copays or coinsurance or out of pocket expenses. It has a higher monthly premium so that it covers almost everything at the time of service. At a Doctor visit, you would use your original Medicare ID card first along with this one.

Example of coverage: There are several different levels of supplements but the most popular one that is available now is the plan G. There is an annual deductible for the part B coverage that the supplement will have, which is $198. Once that is met, essentially everything is covered at 100%. The current plan G monthly premium in Gainesville, FL is $180.60. It’s important to note that the supplement does not cover prescription drugs and those must be purchased in a separate Part D plan. I know this sounds like alphabet soup but stay with us!

Ideal client for this plan: Someone that frequents the doctor, has some health issues or is prone to illness, can afford the higher monthly premium for peace of mind, or someone that just doesn’t want to have to worry about health care costs.

That’s it! Congrats! You made it through the treacherous trenches of Medicare. There are only two routes and you get to pick! We always like to get a better feel for clients’ individual situations and health care needs to better advise the best fit but it’s pretty simple. And as we mentioned, there’s a separate Part D drug plan for prescription coverage with the supplement route… you can get more information on that here: Part D drug coverage. If we can ever be of assistance and help simplify this process or guide you to a decision you’re comfortable with, please contact us at 352-371-7977 or [email protected].

 

What you need to know about Medicare Part D prescription drug coverage

Posted on by McGriff Williams in Blog, Health Insurance, Medicare |

Approaching 65 or retirement can be a time of celebration, but also a time of confusion and overwhelm when it comes the transition from health insurance to Medicare. There are Parts A and B original Medicare, then what’s referred to as Part C for Advantage Plans, but also Supplements and Part D Prescription Drug Plans. It’s a lot, right? Although it sounds like an alphabet soup puzzle, it doesn’t have to be over complicated. Let’s focus on the Part D Prescription Drug coverage for now. This is sold by private companies, in addition to the medical coverage on a Supplement, that goes with original Parts A and B.

 

How do I choose a Part D Plan?

  • You can visit medicare.gov and select the tab titled Drug Coverage (Part D). If you are going the route of an Advantage Plan, there will be Part D coverage built into that plan. But if you’re opting for a Supplement, such as the ever-so-popular Plan F with Florida Blue, you’ll need a separate Part D Plan.
  • This Part D section of medicare.gov is a great tool to compare plans that are specifically offered in your zip code. You can also look up actual medications in their formulary to see what your cost would be, based on what plan and pharmacy you prefer.
  • As you compare coverage, you may see things like copays and coinsurance that apply to certain drugs. There is also a coverage gap referred to as the donut hole. In 2019, the guideline is that once you and your drug plan have spent $3,820 on covered medications, you enter the donut hole. Once in that coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name drugs. In 2019, Medicare will pay 63% of generic drugs during this time as well.

 

When can I enroll?

  • Time frames to consider: You can choose and enroll in a Part D plan within the same 7 month window as regular Medicare. 3 months before your 65th birthday month until 3 months after. Outside of that period, the late enrollment penalty will apply. And if your health status or prescribed medications happen to change throughout the year, you can switch Part D Plans during open enrollment, which begins October 15th, 2019.

 

What if I don’t enroll on time or choose not to have a Part D Plan?

  • It is advised that even if you don’t currently take any regular medications, still enroll in some sort of Part D coverage to avoid the late enrollment penalty. The current penalty fee in 2019 is 1% of the national base beneficiary premium of $33.19 times the number of full, uncovered months you didn’t have Part D or creditable coverage once becoming eligible. The monthly penalty is then rounded to the nearest $.10 and added to your monthly Part D premium. Forever.
  • Keep in mind that your health can change or decline quickly and the cost of prescription medications are at an all-time high. It’s more important than ever to have Part D coverage and it’s worth every penny to avoid astronomical out of pocket expenses and the forever-haunting penalty that comes from going without.

 

This can all seem very complicated so it’s really best and most accurate if you look up your specific medications and compare plans based on your actual needs. We are always happy to help guide you through this process and make recommendations or answer questions anytime.