Medicare Eligible "Consider Your Options"

Many Medicare eligible individuals will consider one of two options to fill in the gaps of Original Medicare. They will select either a Medicare Supplement Plan along with a Prescription Drug Plan or they will choose to enroll in a Medicare Advantage Plan which includes a Prescription Drug Plan.

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Prescription Drug Plans under Part D are regulated by the Centers for Medicare & Medicaid Services (CMS) which sets the minimum level of coverage for any Part D plan. Insurance companies are free to augment coverage and set rates accordingly. The drug formulary for all plans must include at least two drugs in every treatment category. Generic and brand name drugs must be available, but costs will vary depending on how they categorize the drugs and set co-pays. There are currently over twenty (20) Prescription Drug Plans in California. I’ll point you to the best plan based on your list of drugs even if I don’t represent the company.

Medicare Supplements are private insurance plans covering some or all of your share of cost for Part A & B services.  The Centers for Medicare & Medicaid Services (CMS) set the rules for the core benefits of these plans. Supplement plans do not cover prescription drugs. There are eleven (11) plan choices, but not all companies offer all plans. 

The same plan offered by different companies will differ based on price, customer service and any additional services (such as dental & vision) that may be available for added premium. Price varies based on several factors including: the plan you choose, the company selected, your location, age, tobacco use and whether you are signing up during a guaranteed issue enrollment period. If you purchase a Medicare Supplement you should also purchase a prescription drug plan.

Medicare Advantage Plans, sometimes called Medicare Part C or MAPD, are offered by private insurance companies approved by Medicare. You must continue to pay any required premiums for Original Medicare. You may also be required to pay an additional premium depending on the Medicare Advantage Plan you choose. Most of these plans will include your prescription drug coverage, along with help for vision, dental, and hearing aids in addition to providing an annual limit to your out of pocket medical expenses.

Medicare Advantage plan participants are still on Medicare and retain the rights and protections of Medicare, however, all services are handled through the insurance company and the network of doctors and hospitals they contract to provide those services. Advantage plans provide services within geographically defined areas. Extensive traveling outside of your service area could make it difficult to get routine services, but emergency care would still be available.

You must enroll in Medicare Part C or D during your Initial Election Period (IEP). Your IEP extends three months in advance and three months after the month of your 65th birthday or Medicare effective date. If you miss this enrollment window you will have to wait for the Annual Election Period (AEP) which takes place from October 15th through December 7th each year. Part C & Part D plans lock in for the calendar year. There are also special circumstances which may entitle you to a special election period (SEP) such as moving to a new city or State where your options are different or becoming eligible for low income assistance.

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