MEDICARE SOLUTIONS

Medicare Supplemental Insurance (Medi-Gap) is a private health insurance policy that is designed to supplement Original Medicare (Part A and Part B). This means it helps pay some of the health care costs, or “gaps” that Original Medicare doesn’t cover (like copayments, coinsurance and deductibles). Every Medigap policy must follow federal and state laws designed to protect you. Medigap insurance companies can only offer you a “standardized” plan. Each standardized plan must offer the same basic benefits, no matter which insurance company provides it. In most states these are sold as plans A through L. Generally, if you buy a Medi-Gap policy; you must also have Medicare Part A and Part B.


Medicare Advantage Plans (Medicare Part C) is a combination of your Part A and Part B options and must cover at least all of the services that Original Medicare covers (Part A and Part B). One difference is that only private insurance companies approved by Medicare can provide this type of coverage. Part C is often a lower out-of-pocket risk alternative to the Original Medicare Plan, and usually provides extra benefits such as vision, hearing, dental, and/or health and wellness programs and may include prescription drug coverage (Part D). Part C plans often have networks in which you must use the doctors or hospitals that are contracted with the plan. Costs for items and services vary by plan and by insurance company. Medicare Advantage plans have several plan types available. To enroll in a Medicare Advantage Plan you must live in the service area, be enrolled in Part A and Part B of Medicare and not have ESRD (end stage renal disease).


Medicare Prescription Drug Coverage (Part D) is a prescription drug coverage insurance offered by private companies that have been,approved by Medicare. Except for certain situations, you should enroll in Part D when you first become eligible to avoid penalties. Part D was designed to aid people with Medicare, lower their prescription drug costs and to protect against future costs. This prescription drug plan will allow you to have access to medically necessary drugs. Keep in mind Part D plans have a coverage gap (or the “donut-hole”). This means that after you and your plan have spent a certain amount of money for covered drugs; you have to pay all costs out-of-pocket for your drugs up to a limit. Your yearly deductible, your co-insurance or copayments, and what you pay in the coverage gap all count towards this out-of-pocket limit. The limit doesn’t include the drug plan’s premium. Over the counter medicines are not covered by Medicare Part D.


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