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Navigating the world of Medicare
Understanding the basics of Medicare can feel overwhelming — especially if you’re just starting the process. That’s why we’re here to help. From explaining the four parts of Medicare (Part A, B, C, and D), to going through some of the more complicated logistics, we can give you the peace of mind and information you need to feel in control during this next chapter of your life.
Parts A and B: Original Medicare
Original Medicare is managed by the federal government and includes Part A and B. By itself, it’s just a starting point for your healthcare. Here’s what each part covers:
Part A covers:
- Inpatient medical hospital care
- Nursing facilities
- Some home healthcare
Part B covers:
- Cost of doctor’s visits
- Outpatient care
- Some preventative services
Typically you’ll pay a monthly Part B premium and have yearly deductibles you’ll still need to meet. Original Medicare will then cover 80% of the approved amount and you’re responsible for the remaining 20% of the cost.
But Original Medicare doesn’t cover everything. Items and services like most prescription drugs, hearing aids, and routine dental care aren’t covered. There is also no limit on your yearly out-of-pocket costs. That’s why we consider this just a starting point to your overall healthcare.
Part C: Medicare Advantage
Part C is Medicare Advantage Plans. These are plans offered by private insurers that combine the benefits of Parts A and B.
One of the important “advantages” of a Medicare Advantage Plan is that, unlike Original Medicare, Advantage Plans have a maximum out-of-pocket limit per plan year. That means an Advantage Plan can cap your share of healthcare costs. So once you meet your out-of-pocket maximum with a combination of a deductible, copayments, and coinsurance, your Advantage Plan will cover 100% of allowed healthcare costs in the remaining plan year. This helps you control and understand your financial risk a bit more clearly.
Medicare Advantage Plans also come with:
- Dental, vision, and hearing benefits
- Things like fitness memberships and transportation to doctor’s appointments and pharmacies
- Part D plans that include prescription drug coverage
Part D: Medicare Advantage Prescription Drug Coverage (MAPD)
While some Medicare Advantage Plans (Part C) offer Part D prescription drug coverage, not all do. And many Americans rely on prescription drugs to maintain their health and well-being. So it’s important to consider if you need a plan for prescription drug coverage.
MAPD are plans that combine medical coverage and prescription drug coverage. Prescription Drug coverage (Part D) helps cover the cost of your prescription drugs. To get this benefit, you need to purchase a Prescription Drug Plan (PDP) to add to your Original Medicare (Part A and B), or enroll in a Medicare Advantage plan with Part D prescription drug coverage (MAPD).
Our Part D Plans include:
- Free prescription delivery
- $0 or low copays for a 90-day supply of many generic medications
The Different Stages of Payment
The amount you pay before a plan covers your prescription drug costs, if applicable.
The plan pays its share of the cost, and you pay your share. You are in this stage until your payments and plan’s payments total $4,130 for the year.
When your drug costs and plan payments for the year reach $4,130 you enter the Coverage Gap Stage, commonly known as the “Donut Hole.” In this stage, your out-of-pocket costs for the year reach $6,550.
After your out-of-pocket costs for prescription drugs reach $6,550, the plan will pay most of your drug costs for the rest of the year. You will pay either 5% of the cost of the drug, or a co-pay of $370 for generic drugs or $9.20 for all other drugs, whichever is greater.