Medicare is a federal program to provide health and prescription coverage to people 65 or older, that have ESRD of any age, and those disabled for at least 24 consecutive months. There's different parts to Medicare that provides Hospital (Part A), Medical (Part B), Medicare Advantage (Part C), and Prescription Drugs (Part D). To cover cost not covered by what we refer to as Original Medicare (Parts A & B) you can purchase a Medicare supplement plan, or replace original Medicare with a Medicare Advantage plan (Part C), and to cover outpatient prescription drugs a Medicare prescription drug plan (Part D).
First, I would like to focus on Medicare Advantage plans (Part C). A Medicare Advantage plan can be purchased from private insurance companies with a contract with Medicare, and it will be the insurance companies responsibility to pay your doctor's, hospital, and if prescription drugs are part of the plan the pharmacy referred to as MAPD. Medicare Advantage (MA) plans comes in different types like an Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Special Needs Plans (SNP), Medicare Savings Accounts (MSA), and Private Fee For Service (PFFS), these plans can vary depending on the area. To be eligible for a Medicare Advantage plan you must have Parts A & B of Medicare, live in the plans service area, and not have ESRD.
A Medicare Supplement also referred to as "Medigap" insurance are offered by private insurance companies and doesn't have to have a contract with Medicare, but are regulated by the states Department of Insurance. Medicare Supplements covers some or all of what original Medicare doesn't pay depending on the plan type selected, the standardized plan types are represented by letters Plan A through Plan N excluding E, H, I, and J and each has it's coverage limits. These plans are standardized and are the same across the country except for MA, WI, and MN who are exempt. The insurance company will also set rates, and what plans will be available in the area you live.
Medicare Prescription Drug Plans (Part D) are administered by private insurance companies with a contract with Medicare and their responsible for paying the pharmacy. The insurance company has a drug list referred to as a Formulary of covered Medicare Part D drugs, and their cost. Each company offering Medicare Part D drugs must include at least two drugs in each classification of drug type at minimum to be considered creditable and in compliance. To be eligible to enroll you must have either Part A and/or Part B of Medicare
Medicare can be a winding road and difficult to understand with all the parts and different types, so if you need someone that can help make some sense of it all please contact us for more information.
Kevin Oliver Insurance Agency, LLC