Understanding Medicare Plans
Medicare health insurance is available to people who:
- Age 65 or older
- Are under age 65 with specific disabilities
- Have End-stage Renal Disease (kidney failure).
When deciding, we urge you to review your options, compare costs, and find the one that meets your health coverage needs and budget. For example, if you join a Medicare Advantage plan, it may or may not include your doctor in its network. AARDY's licensed Medicare experts will listen to your concerns, ask questions, and help you decide on the best plan.
Medicare Supplement Plans
- Coinsurance – Cost-sharing based on a percentage
- Copayments – Payment due at the time of service
- Deductibles – Amount you must contribute before full benefits kick in
Medicare Supplement Coverage
While the federal government provides Medicare Parts A and B, private insurance companies manage Medicare Supplements and Medicare Part D Drug plans. The plans are Medicare-approved and standardized by the government. However, Medicare supplement coverage can vary in some states.
Typically, all Medicare supplement plans cover:
- Medicare part A coinsurance
- Medicare Part A hospital services up to 365 day after benefits end
- 50% to 100% of Medicare Part B coinsurance or copayment
- First 3 pints of blood for a medical procedure
- Medicare Part A hospice care coinsurance and copayment
Medicare supplement plans range in coverage from basic to robust. More comprehensive policies cover all the above, and:
- Medicare Part A skilled nursing facility care coinsurance
- Medicare Part A deductible
- Medicare Part B deductible
- Medicare Part B excess charges
- Foreign travel emergencies up to plan limits
However, Medicare supplements do not include prescription drug coverage. You can buy a separate Medicare Part D plan to cover medications.
Medicare Supplement Costs
Medicare supplement plans have a monthly premium in addition to Medicare Part B. Although Medicare supplements have the same coverage from state to state, insurance companies set the prices on their plans. Consequently, two insurers can offer identical plans for different prices. Even if you do not need medical treatment, you must pay the premium.
Rates are based on age, sex, health status, state of residence, and other factors.
Medicare Supplement Plans K and Plan L have an out-of-pocket maximum. The cap is crucial if you have a catastrophic medical event. Otherwise, you could pay the coinsurance endlessly.
Medicare Advantage Plan
Medicare Advantage Coverage
They cover Medicare Part A and Part B in a single plan. Also, most include prescription drug coverage. Some even offer additional benefits that Original Medicare does not provide, like dental, vision, hearing, and SilverSneakers.
Medicare Advantage Costs
Like Medicare supplements, Medicare Advantage plans typically have a monthly premium. However, some Medicare Advantage plans offer coverage for $0 premium. They can be more affordable on a short term basis than Medicare supplements.
Some Medicare Advantage plans have a deductible you must cover, and others do not. One policy might charge you a 20% coinsurance to see your primary care doctor while a different plan might not charge you at all. Like Medicare supplements, you can choose how much insurance protection you need.
When you review Medicare Advantage plans, look at all programs available in your area.
Medicare Prescription Drug Plan
Generally, Original Medicare does not cover prescription drugs you use at home. There are two ways to get prescription drug insurance:
- Enroll in a standalone Medicare Part D prescription plan works with Original Medicare
- Get a Medicare Advantage policy that includes prescription drugs
Medicare Part D Coverage
Medicare Part D drug plans use a formulary list to determine how much you pay for a prescription. The formulary has four tiers of coverage, ranging from a low copay to not covered at all.
Plans decide which drugs are covered or not.
As you shop for a prescription drug plan, make sure the medications you take are included before you sign up. Plans can change each year, so it's wise to check annually.
If your plan changes during the year, the plan must notify you within 30 days of the effective date.
Medicare Part D Costs
Most Medicare drug plans charge a monthly premium. This is due in addition to the Medicare Part B and Medicare supplement premiums. However, some Medicare Advantage plans include prescription drugs.
Drug plans have annual deductibles you must pay before the policy begins coverage. If you use a pharmacy in-network, there may be no deductible.
Where Can I Get Help with Medicare?
AARDY is here to help you do that. We make understanding Medicare simple.
AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs. Our service is free. You're never obligated to enroll.