Don’t Be Medi-Careless!™

Medicare Advantage

Medicare Part C, also called Medicare Advantage Plans, is an alternative to original Medicare and includes Parts A & B which are hospital insurance and medical insurance. New York Medicare Advantage Plans are offered by private insurance companies who have been approved by Medicare.

Medicare Advantage Plans can also include additional coverage like Medicare Part D prescription drug plans, vision, dental and/or hearing coverage. Each provider follows guidelines set by Medicare; however Medicare Advantage Plan rules for how you get services can vary, such as how you get services (whether you must use doctors and hospitals in-plan) and what your out-of-pocket costs will be. Some Advantage plans offer prescription drugs, some do not. You can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you’re in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, your Medicare Advantage Plan will be cancelled and you will be reassigned to Original Medicare.

We can help you decide whether a Medicare Advantage Plan is the right choice for you.

Medicare Supplemental

A Medicare supplement (Medigap) insurance, sold by private companies, can help fill in the ‘gaps’, or, pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. There are several standardized Medicare Supplement plans. Choosing a plan can be tricky with rates varying from one company to another. Review your current situation when considering which plan will best suit you.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

Medicare Part D

Medicare Part D is also known as prescription drug coverage, and is designed to help seniors lower their prescription drug expenses and protect against future costs. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, you’ll likely pay a late enrollment penalty. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

If you already have Medicare Advantage Plan insurance, chances are your prescription drug coverage is included.