Medicare Supplements (Medigap) & Part D Plans
Medicare supplements, Medicare Advantage plans and Part D prescription drug plans are available for Medicare eligible individuals age 65 or older or individuals with other qualifications such as disability. Individuals will need both Medicare Part A and Part B to apply for
supplements and Part D plans. Part A covers hospitalization, and
is free if you qualify. Part B covers primary care services and has
a premium based on your last 3 years of salary. Medicare and
supplemental coverage typically begins the 1st of the month in
which an individual turns age 65, if in the initial enrollment period.
With Medicare Supplements, insured can see any provider
accepting Medicare patients, nationwide. Coverage picks up
where Medicare leaves off. Plan F is the most comprehensive
Medicare plan and covers all Medicare approved expenses,
as long as you see a Medicare approved provider, so there are
no out of pocket expenses except the premium.
Medicare Advantage plans (Part C) take the place of original
Medicare and is sold through carriers, much like Medicare
Supplement plans. These plans typically have a low premium,
however, have high out of pockets costs compared to Medicare
Supplements. Medicare Advantage plans also use specific limited networks.
Part D prescription drug plans have specific networks and specific formularies, which vary by carrier. Many carriers offer multiple plans to choose from with a variety of copays for Tiered drugs. In 2019, the Part D coverage gap (donut hole) starts when an insured has reached $3,820 in total annual drug costs. Catastrophic coverage starts when an insured has spent $5,100 on out of pocket drugs, at which time the out of pocket expense for drugs decreases to around 5% of cost.
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