Original Medicare (Part A and Part B) is managed by the federal government and provides Medicare-eligible individuals (called beneficiaries) with coverage for and access to doctors, hospitals, or other health care providers who accept Medicare. It is a fee-for-service plan, meaning that the person with Medicare usually pays a fee for each service. Medicare pays its share of an approved amount up to certain limits, and the person with Medicare pays the rest. You must be eligible for Part A and/or enrolled in Part B to enroll in Supplement, Medicare Advantage, or Part D Prescription Drug Plans.
Medicare Supplement Plans
A Medicare Supplement policy (also known as Medigap or Med Supp) is Senior Health Insurance sold by private companies to expand health coverage for beneficiaries where the Original Medicare plan coverage falls short. It can cover out-of-pocket costs such as copays and deductibles for doctor visits, hospitalization, and other medical services. Beneficiaries pay a monthly premium, but have few additional out-of-pocket expenses. There are 10 standardized plan types available in most states, and each plan is labeled with a different letter that corresponds with a certain level of basic benefits.
Medicare Advantage Plans
Medicare Advantage Plans are health care options that are an alternative to Original Medicare, though to be eligible you must still pay the Part B premium. Medicare Advantage Plans must offer coverage that is as good as or better than Original Medicare. Medicare Advantage beneficiaries may receive extra benefits not covered under Original Medicare or Supplement plans. Beneficiaries may or may not pay a monthly premium and these plans have additional copays and deductibles. Medicare Advantage plans can also include Rx coverage.
Medicare Prescription Drug Plans
Medicare Prescription Drug Plans are available to Medicare beneficiaries to help with their prescription drug costs. If you decide to enroll in a Medicare Part D plan, your costs will include monthly premiums, and may include out -of pocket expenses such as copays, coinsurance, and annual deductibles. Medicare Part D coverage is available through private insurance companies, who can set their own costs. Availability is determined by county. Costs may vary by plan, depending on the plan’s formulary (list of covered drugs) and which private insurance company offers the coverage.
Providing A Stress-Free Path Through The Medicare Process
***Prior to any discussion of services for Medicare, a Medicare scope of appointment form (SOA) detailing exactly which items you wish to discuss must be completed. This form serves as protection from unwanted solicitations and instructs your agent which medicare insurance products he or she may present to you.***