Medicare 101 – Medicare Coverage Options

Medicare 101 medicare coverage options graphicMedicare can be a confusing topic, and Medicare Solutions is here to help. Medicare health insurance is offered to U.S. residents who meet certain criteria. We offer our services to those eligible and have the experience to help you make an informed decision about Medicare health insurance. Here is a quick overview of your options. To get things started and further go into depth about your options, you can give our licensed sales agents a call today.

The Medicare Alphabet

  • Medicare Part A
    • Hospital part of Medicare Part A and Part B
    • Usually no premium if you or your spouse paid Medicare taxes while working; this is sometimes called “premium-free Part A”
    • May be automatically enrolled
  • Medicare Part B
    • Medical part of Medicare Part A and Part B
    • Most people pay the standard monthly premium amount
    • After deductible is met, you typically pay 20% of Medicare-approved amount for some services
  • Medicare Part C
    • Medicare Advantage Plans
    • Offered through private health plan carriers that are approved by Medicare
    • May offer additional coverage like vision, hearing and dental
  • Medicare Part D
      • Prescription drug coverage
      • Medicare offers to everyone eligible for Medicare Part A and Part B
      • Must join a plan run by an insurance company or other private company approved by Medicare

    You Have Options for Additional Coverage Beyond Medicare Part A and Part B

First Option
Medicare Advantage Plans (Part C)

  1. Provides Part A and Part B benefits
  2. All plans are approved by Medicare
  3. Generally has a monthly premium, in addition to your Part B monthly premium
  4. May include additional benefits (routine vision, gym membership)
  5. Available through private insurance companies approved by Medicare
  6. Most plans include prescription drug coverage

Second Option
Medicare Supplement or Medigap policies

  1. You must have Medicare Part A and Part B
  2. Plans are standardized and must follow federal and state laws
  3. You pay a monthly premium for a Medigap policy in addition to the monthly Part B premium
  4. Available through private insurance companies

Third Option
Medicare Prescription Drug Coverage (Part D)

  1. Available as a stand-alone Prescription Drug Plan or as part of a Medicare Advantage Plan
  2. Different plans may have different cost-sharing levels
  3. Plans may have deductibles
  4. Plans may cover prescription drugs in the Coverage Gap
  5. Most plans have in-network retail and mail order pharmacies

How Medicare Part D Works

The below is an example and does not represent a specific plan.

You Pay Co-Payment Retail Price
$7 $100
$29, etc. $250, etc.

When you and the Part D plan together, spend a combined total of $3,700 on covered prescription drugs in 2017, you are in the Donut Hole or Coverage Gap.  Once you reach the coverage gap you will pay no more than 40% in 2017 of the plan’s cost for covered brand-name prescription drugs.  Although you’ll pay no more than 40% in 2017 for the brand-name prescription drug, what you pay plus 50% manufacturer discount payment – will count as out-of-pocket costs which will help you get out of the coverage gap.  In 2017, Medicare will pay 49% of the price for generic prescription drugs during the coverage gap while you pay the remaining 51%.  Find more details about costs in the coverage gap at Medicare.gov/part-dcosts/coverage-gap.

Medicare Solutions can compare plans for you so you can get the Medicare health plan that helps meets your health and financial needs. It may be a little overwhelming at times, we understand. Medicare Solutions is here to assist you in the process to help find what suits your individual needs. We take the time to talk to you for however long it may take until you are satisfied and comfortable with the choices. Medicare Solutions is about personal attention. You can speak with a live licensed sales agent, not a computer. Call us at 844-839-0813 to start the process. Gain the information and attention you deserve to make the decision about Medicare Health Insurance that may be best for your needs.

Medicare may sometimes be confused with Medicaid. Click here to learn more about the differences between Medicare and Medicaid.