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After enrolling in Original Medicare Parts A & B, it is imperative to understand that Original Medicare is an eighty/twenty plan. Meaning Medicare only pays 80% of covered medical expenses, and the Medicare beneficiary is responsible for the remaining 20% of the costs for Medicare Part A and B. There is no cap for the 20% a beneficiary is liable to pay. Only having Original Medicare puts people at unlimited financial exposure. Additional coverage is possibly the most crucial decision one can make after enrolling in Medicare.
Exploring these Medicare options is where most of the confusion about Medicare starts. First, it is optional, but given the affordability of one of the options, it is not advisable to dismiss how it can help combat the excess Medicare expenses. Second, of the two choices, one option is managed health care, and the other is not. Understanding the advantages and disadvantages of each option is vital. Finally, Medicare Part D, prescription drug coverage, is another determination because it is optional, just like supplemental insurance. But, opting out of Medicare Part D when first eligible will create a lifetime CMS penalty to the monthly premium if a person enrolls in prescription drug coverage later.
Medicare Supplement Insurance – aka Medigap Plans
A Medigap plan is one of the options available to help reduce the 20% exposure left by original Medicare. They are CMS approved insurance plans offered through private health insurance companies. They can ease some, or almost all, of the expenses associated with Medicare’s copayments, coinsurance, and deductibles. Medigap policies can also offer coverage for services that original Medicare doesn’t cover. For instance, medical care when traveling outside the United States. With original Medicare and a Medigap policy, Medicare will pay its share of Medicare-approved amounts, and the Medigap policy pays its share.
Medigap Plans Cost Around $100 to $150 A Month, Depending On The Plan Chosen. Prescription Drug Plans Cost Around $30 to $70 A Month, Depending On The Plan Chosen.
Medicare Advantage Plans – aka Medicare Part C
A Medicare Advantage plan is another option available to help reduce the 20% exposure left by original Medicare. They are CMS approved insurance plans offered through private health insurance companies. They combine original Medicare, Part A, Part B, and generally Part D into one plan. Enrolling in a Medicare Advantage plan requires a person to enroll in Medicare Part A & B and reside in the plan’s service area. Medicare Advantage plans are available as an HMO or PPO. Medicare Advantage plans, at a minimum, include all benefits, services, and coverages outlined in original Medicare. They generally have additional benefits and services Medicare does not cover, such as:
Medicare Prescription Drug Plans – aka Medicare Part D
Part D Prescription Drug plans are CMS approved plans offered through private health insurance companies. These plans are found as either a Stand-Alone Prescription Drug Plan or a Medicare Advantage Prescription Drug Plan (MAPD). They cover brand-name and generic medications supplied by a pharmacy. Coverage varies by plan, and each plan has a formulary. A formulary is a list of the drugs covered by that plan.
With all this said, please review the Medicare 101 page, ‘The Four Parts of Medicare Plus Supplement,’ for a more in-depth explanation of your Medicare options.