Medicare

Turning 65? Approaching Retirement?

Know Your Medicare Choices

At Hilgerman Insurance Solutions, we specialize in guiding you through the complexities of Medicare, often referred to as the “Medicare maze.” Our team is dedicated to demystifying the process and providing you with insights that insurance companies may not disclose. Let us help you understand the ins and outs of Medicare and assist you in achieving the best possible outcomes.

Before choosing a plan Hilgerman Insurance Solutions your Medicare agent wants to be sure you know the difference between your many options; In particular how Medicare Supplements and Medicare Advantage Plans differ. Many people sign up for Advantage plans thinking they are Supplements, they are not.

Medicare Supplement Insurance Plans

A Medicare Supplement Insurance Plan complements original Medicare by covering the costs that Medicare doesn’t. If a caregiver accepts Medicare, they will also accept this Supplement, simplifying the billing process as they only need to bill Medicare. Typically, Medicare covers 80% of the expenses, and the Supplement covers the remaining 20%. However, it’s crucial to remember that this Supplement doesn’t provide Prescription Drug Coverage (Part D, PDP). Failing to acquire a PDP when first eligible can result in a penalty later on, although there are some exceptions. Additionally, while the price of a Medicare Supplement might increase over time, the coverage it offers remains consistent.

Medicare Advantage Plan

Medicare Advantage Plans, also known as “Part C” or “MA Plans,” serve as a comprehensive alternative to Original Medicare. These plans are provided by private firms that have received Medicare’s approval. Enrolling in a Medicare Advantage Plan doesn’t mean you lose your Original Medicare coverage. These consolidated plans encompass Medicare Part A, which covers hospital services, and Part B, offering medical insurance. Most MA Plans also incorporate Medicare Part D for prescription drug coverage.

Medicare Prescription Drug Plans (Part D)

Medicare Part D, also known as the Medicare Prescription Drug Plan, provides additional drug coverage to individuals enrolled in Original Medicare. It is also applicable to certain Medicare Cost Plans, Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Each Part D plan comes with a distinct formulary, a list that includes all the covered prescription drugs. The plan classifies these drugs into various “tiers,” each associated with a different cost. Medications listed on lower tiers are generally less expensive than those on higher tiers.

If you’re prescribed a drug that is listed on a higher tier, but your healthcare provider believes it is essential for your treatment over a similar, lower-tiered drug, you have the option to request an exception. By doing so, you or your provider can appeal for a reduced copayment, making your essential medication more affordable.

Medicare Supplement Insurance

A Medicare Supplement Insurance Plan is used with original Medicare. Any caregiver that accepts Medicare may take a Medicare Supplement. Medicare pays their part (generally 80% of Medicare-covered benefits) and sends the remainder of the bill to the Medicare Supplement carrier which pays their part (generally 20%). It is important to note that Medicare Supplements do NOT include Prescription Drug Coverage (Part D, PDP). For those that do not enroll in a Prescription Drug Plan when first eligible, there will be a penalty when they do get the Prescription Drug Plan. (there are exceptions to this) A Medicare Supplement does not change year to year (although the cost does generally go up, however, the coverage does not change).

Medicare Advantage

A Medicare Advantage plan works differently than a Medicare Supplement. With a Medicare Advantage Plan a private company provides a plan that includes Original Medicare (Parts A and B) and prescription drug coverage. You remain in the Medicare system, but you assign your Part A and B to the Medicare Advantage plan to manage. You will present one card to the provider with a Medicare Advantage plan. These plans follow the same type of module as many group plans such as HMO or PPO.

With this type of plan, it is important to remember several things:

Most Medicare Advantage Plans have specific networks, so be sure your doctor, hospital, and auxiliary care providers are within the network. (Otherwise, you will be paying higher costs and in some cases are responsible for 100% of care outside the network).
Medicare Advantage Plans may have co-pays associated with them however, there are many that offer a zero premium and zero deductible. It is important to be aware of the copays because they can add up.
Medicare Advantage plans have a maximum Out-of-Pocket or (MOOP) which is the amount you must pay before the insurance company pays 100% of your medical care for that year.
Medicare Advantage plans may have some value-added benefits such as gym membership, transportation, dental, vision or hearing and more.
Be aware that when switching to a Supplement from a Medicare Advantage Plan you will also need to add a Part D, and this can only be done using a Special Enrollment Period or during the Annual Enrollment Period. (There are several types of Medicare Advantage Plan options that do NOT have the Part D included. This is something you need to keep in mind when choosing any plan).

Because these plans vary even from county to county, we strongly recommend that you talk to an independent insurance agent to help you choose the one that best suits your needs.

Medicare Part D Prescription Plans

When you are enrolled in Medicare, a prescription drug plan is available to cover your medications. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage (as good as or better than Medicare), or you don’t receive Extra Help, you’ll likely pay a late enrollment penalty. To get prescription drug coverage, you must join a plan offered by an insurance company approved by Medicare during your eligibility time or during the Annual Election Period which occurs from October 15 to December 7 each year. Each plan can vary in monthly premium cost and medications covered.

Also, not all Part D plans are the same. Although they are required to be at least as good as the Medicare model they can vary greatly in costs, co-pays, and specific drugs that are covered. It is important to review which one suits you and continue to check each year because they (like Medicare Advantage Plans) do change every year.

Prescription Drug Plans (sometimes referred to as “PDPs” are a stand-alone prescription drug plan that is purchased alongside a Medicare Supplement Plan or is available on some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

What drug plans cover

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Prescription Drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have different costs. A drug in a lower tier will generally cost you less than a drug in a higher tier.

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