Medicare

Supplements

Original Medicare

Part A and Part B

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Medicare supplement insurance, or 'Medigap', is private insurance that helps pay for some out-of-pocket costs not paid by Original Medicare. You pay a premium for a Medigap policy in addition to your Part B premium and maybe your Part A premium too, in some limited cases.

 

Medigap does not include prescription drug coverage. You need a separate Part D drug plan to cover medications. Part D plans have their own premium. Even if you're not taking any medications, you should have a Part D drug plan from the beginning of when you start Medicare. Otherwise, you may end up paying a penalty for as long as you have Medicare prescription drug coverage. See the discussion for Part D drug plans below for more information.

 

Medigap does not cover routine dental, vision, hearing exams, hearing aids, or virtual Telemedicine benefits. Consider getting and ancillary plan to cover these services.

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Medicare

Advantage

Part C

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Advantage plans are private insurance plans offered by insurance companies approved by Medicare. These plans combine Part A and Part B benefits into one plan and most plans include combinations of prescription drug coverage, routine dental, vision, hearing exams and hearing aids, virtual office visits, wellness programs and fitness membership too.

 

Advantage plans contract with a network of doctors and hospitals to provide care to plan members. Some plans may require you to choose a primary care doctor (e.g., HMO plans) while other plans allow for more flexibility (e.g., PPO plans).

 

Advantage plan premiums can be much less than Medigap plans and may even be $0 premium. Zero premium Advantage plans without drug coverage are ideal for Veterans.

 

Special Needs Plans (SNPs) are also available for people with chronic conditions, or for those who are on Medicaid or institutionalized.

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Part D

Drug Plans

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Part D drug plans are private insurance plans offered by insurance companies approved by Medicare. Medicare sets standards for the types of drugs Part D plans must cover, but each plan chooses the specific brand name and generic drugs for its formulary. Each plan negotiates prices with drug manufacturers and pharmacies. Your copays or coinsurance rates are based on your plan’s negotiated prices and on guidelines set by Medicare.

 

Part D has four coverage stages:

  • Annual Deductible => (not all plans may have a deductible)

  • Initial Coverage => out-of-pocket costs up to $4,020 (2020)

  • Coverage Gap (aka Donut Hole) => up to $6,350 (2020)

  • Catastrophic Coverage => here, you pay a small copay or coinsurance for the rest of the year.

 

The coverage stage cycle resets at the beginning of each plan year, usually on January 1.

Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

 

Extra Help is estimated to be worth about $5,000 per year. Many people qualify for these big savings and don’t even know it. To help Social Security determine if you are eligible for Extra Help, you will need to file an Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020).

 

Visit the Resources section in this website to download a copy of the Social Security document that describes more information and how to apply for the Extra Help benefit.

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By all means

work with an Independent Agent who has access

to multiple insurance offerings.

Phone

Email

Website

Address

941-284-7275

Dan@srqhiadvisory.com

www.srqhiadvisory.com

6600 Draw Lane

Sarasota, FL  34238-5138

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