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Do you qualify for Medicare? You might have Medicare plan options beyond the federal program, Original Medicare (Part A and Part B). Find out about Medicare Advantage plans, Medicare Prescription Drug Plans, and Medicare Supplement plans.
If you decide to stay with Original Medicare, you might be able to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. All plans cover Medicare Part A hospital coinsurance costs at 100%. Beyond this one benefit, the plans vary on what they cover with some plans being more comprehensive than others. Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans.
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Different Types of Medicare Plans
Medicare Supplement Insurance Plans
Medicare is insurance coverage provided by the federal government for individuals over 65 and those under 65 who qualify based on Social Security disability or End Stage Renal Disease
Medicare is divided into three (3) forms of coverage. Medicare Part A provides benefits during a hospitalization. Medicare Part B covers medical services related to doctors, labs, x-rays, imaging, durable medical equipment, or dialysis. Medicare Part D is coverage for prescription drugs purchased at a retail pharmacy or mail order pharmacy.
Medicare Supplement plans are available from private carriers to provide benefits not covered by traditional Medicare. Benefits paid by a Medicare Supplement plan can include the Part A deductible, Part B deductible, and the Part B 20% coinsurance. Each Medicare Supplement provides standardized benefits, which makes for easy comparison of various plans.
Medicare Advantage Plans
As an alternative to Medicare Supplement coverage, Medicare Advantage plans (also known as Part C) are offered by private carriers, that contract with Medicare, to provide Part A and Part B benefits. Medicare Advantage plans are an alternative to Original Medicare.
Most Medicare services are covered through the plan and many Advantage plans include prescription benefits and extra benefits not covered under Original Medicare. A covered individual’s services are not paid by Original Medicare but are provided by the private carrier.
Medicare Part D Plans
Medicare prescription benefits were enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Medicare Part D is an optional federal-government program to provide benefits for self-administered prescription drugs. Unlike Medicare Part A and Part B, there is no public option for Medicare Part D. All coverage is provided by private companies
All Medicare Part D plans must provide at least a standard level of coverage established by Medicare. Plans can offer different combinations of coverage and cost sharing. Medicare Part D coverage can differ in the covered prescription drugs, also known as a formulary, plan deductible, cost of prescription drugs and allowable pharmacies.