Medicare Advantage Plans (Part C)

Medicare Advantage Plans (Part C)

Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage.  Medicare Advantage Plans are offered by Medicare-approved private companies that must follow rules set by Medicare.  Most Medicare Advantage Plans include Drug coverage (Part D).  In many cases, you'll need to use health care providers who participate in the plan's network and service area for the lowest costs.  These plans set a limit on what you'll have to pay out-of-pocket each year for covered services, to help protect you from unexpected costs.  Some plans even have zero monthly premiums.

Medicare Supplement Insurance Plans

Medigap is Medicare Supplement Insurance that helps fill the "gaps" in Original Medicare and is sold by private companies and offered by Powers Financial and Insurance Group.  Original Medicare pays for much, but not all of the cost for covered health care services and supplies.  A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:      




Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.  if you have Original Medicare and you buy a Medigap policy, here's what happens:

        -Medicare will pay it's share of the Medicare approved amount for covered health care costs.

        -Then, your Medigap Policy pays it's share. 

6 things to know about Medigap policies

        1.  You must have Medicare Part A and Part B

        2.  A Medigap policy is different from a Medicare Advantage Plan.  Those Plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare Benefits.

      3.  You pay the private insurance company a monthly premium for your Medigap policy.  You pay this monthly premium in addition to the monthly Part B premium that you pay Medicare.

      4.  A Medigap policy only covers one person.  If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

      5.  You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

      6.  Any standardized Medigap policy is guaranteed renewable, even if you have health problems.  This means the insurance company can't cancel your Medigap policy as long as you pay the premiums.

Prescription Drug Plans (Part D)

Prescription Drug Plans (Part D)

Original Medicare (Part A and Part B) does not cover prescription drugs, so you will need to enroll in a Stand Alone Prescription Drug Plan.  Or, enroll in a Medicare Advantage Plan (Part C), that includes prescription drug coverage.  The cost that a member pays fluctuates throughout the year.  Below are the 4 stages for 2023, and are the same for PDP and MAPD.

Stage 1: Deductible

Member pays 100% of drug costs (if applicable), until they reach their annual deductible.

Until out-of-pocket total reaches $505.00.

Stage 2: Initial Coverage

Member pays cost share until the total costs of drugs reach the Initial Coverage Limit (ICL).  The ICL includes everything the member and plan pay.

Until total drug cost reaches $4,660.00.

Stage 3: Coverage Gap

Member pays 25% co-insurance for generic and brand drugs.  Sometimes this stage is referred to as the "donut hole".

Until out-of-pocket total reaches $7,400.00.

Stage 4: Catastrophic Coverage

The Member pays no more than 5% of the cost for covered drugs, or $4.15 for generics and $10.35 for brand names drugs (whichever is greater).

Until the end of the calendar year.

Do you need help enrolling, want a free quote, or have a question?

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