ABC’s of Medicare Advantage, Supplements, and Prescription Drug Programs

We discussed the specifics of Medicare Part A and B in our last newsletter. While these plans provide broad coverage, there are still some gaps and the potential for large out of pocket costs. Medicare Advantage, Supplement and Prescription Drug plans were designed to fill in these gaps.

Medicare Advantage Plans:

• You must be enrolled in Medicare Part A&B

• You contract with a separate insurance company and Medicare pays them a certain amount every month for your care

• Some participants may even qualify for this coverage at a reduced rate or even no premium depending on their income.

• These plans will also typically include a Prescription Drug program (see Medicare D outline below).

• One of the major concerns with these plans is that not all areas have a sufficient participating physician or facility base to provide adequate services to the participants.

• Another drawback is a higher potential out of pockets costs for severe, ongoing medical issues.

Medicare Supplement Plans:

• These plans are structured to pick up where Medicare leaves off and can pay for the Part A Deductibles, Skilled Nursing Facility charges (through 100 days), Part B Deductible and the 20% of Medicare Approved fees billed by physicians.

• Medicare Supplement plans are sold through the insurance industry

• There are standardized plans labeled A – N that offer varying benefit levels and costs and Lutgert Insurance sells many of these plans.

• Limited coverage is available on some plans for Emergency Care outside of the US.

Medicare Drug Plans:

• Prescription Drug Coverage purchased through the insurance marketplace and has three levels of coverage.

o The first level has co-pays for generic, brand and specialty drugs.

o When the total cost of all drugs reaches the first cost benchmark ($2,970 for 2013), level two is activated and now the plan participant will pay a percentage of the overall cost up to the next benchmark ($4,750 for 2013).

o When costs for the year reach the second benchmark, level three will apply with much lower co-pays for all eligible prescriptions.

• There are typically two or three plans available and the monthly premiums will range from $15-$87 per person.

 

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