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

  • Part A
    • Hospital – Part of Original Medicare
    • Usually no premium – “premium-free part A”
    • May be automatically enrolled
  • Part B
    • Medical – Part of Original Medicare
    • Standard Monthly Premium
    • After deductible is met, you typically pay 20% of Medicare-approved amount for some services
  • Part D
    • Prescription Drug Coverage
    • Through prescription drug plan carriers

You Have Options for Additional Coverage beyond Original Medicare

First Option
Medicare Advantage Plans (Part C)

  1. Helps cover Part A, Part B, and may include Part D of Medicare
  2. All plans approved by Medicare
  3. Generally have a monthly premium per month
  4. Additional advantages (routine vision, fitness programs)
  5. Available through national/regional private insurance carriers
  6. Most plans include prescription drug coverage

Second Option
Medicare supplement or Medigap plans

  1. Added to Original Medicare
  2. Pays the cost sharing associated with Medicare
  3. Plans are standardized by Medicare
  4. Have to pay premiums for a Medigap policy
  5. Available through private insurance companies

Third Option
Medicare Prescription Coverage (Part D)

  1. Available through 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 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-Pay Retail Price
$7 $100
$29, etc. $250, etc.

When the co-pay and the plan’s share for each covered drug, plus the deductible, totals $3,700 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 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 drugs during the coverage gap while you pay the remaining 51%.  Find more details at medicare.gov.

*This does vary by plan.

Medicare Solutions can compare plans for you so you can get the Medicare Health Plan that meets your health and financial needs. It can all get a little overwhelming at times, we understand. Medicare Solutions is here to assist you in the process to 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 of gaining the information and attention you deserve to make the decision about Medicare Health Insurance that is best for your needs.

Medicare is sometimes confused with Medicaid. Click here to learn more about the difference between Medicare and Medicaid.