Can you solve this word problem?
If A + B = C and D is only sometimes included in C, how many prescriptions does it take to make any sense of Medicare?
Does Medicare seem like an unsolvable word problem to you? If so, you are not alone. We’ve done our best to simplify it and pull out the key details that are really helpful to know.
Medicare’s open enrollment (aka Annual Election Period) is from typically in October through December every year. What does this mean for you? Why should you look at your policy and do you have to? Medicare says the answer is based on what type of plan you currently have.
- If you have Original Medicare (aka Part A and Part B) plus a supplemental plan (often called a Medigap) and are happy with your coverage, you do not need to make a change.
- If you have a Part C Plan (aka Medicare Advantage) or a Part D plan, you should review all your coverage options even if you are happy with your current coverage because plans change their costs and benefits every year. To do that, read your Annual Notice of Change (ANOC), which you should have received from your plan by September 30. It lists the changes in your plan, such as the premium and copays, and will compare the benefits in 2023 with those in 2022.
TIP: You are likely getting a LOT of solicitations related to Medicare right now. You can throw most of it out, but keep anything mailed to you from the Social Security office or the Centers for Medicare & Medicaid Services.
What if you want to make a change to your plan?
According to Medicare, if you want to make a change, the best way to enroll in a new plan is to call 1-800-MEDICARE (1-800-633-4227). Enrolling in a new plan directly through Medicare is the best way to protect yourself if there are problems with your enrollment. Medicare suggests that you write down everything about the conversation when you enroll through Medicare, including the date, the representative you spoke to, and any outcomes or next steps.
What about Medicare overall? What’s good to know about the different plans? Well, we’ve covered that here…
What is Medicare Part C? (aka Medicare Advantage Plans)
Part C bundles Part A and Part B and provides additional benefits. Here are some key things to know about Medicare Part C:
- Plans are offered by private companies approved by Medicare.
- In most cases, you will need to use doctors that are in the plan’s network in order to get the lowest co-pays.
- Plans may have lower out-of-pocket costs than coverage just under Part A and Part B.
- Each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care).
- Not all plans include coverage for prescription drugs so if you need prescription drug coverage, be sure to pick a plan that includes that.
- Plans may offer some extra benefits that Plan A and Plan B don’t cover – like vision, hearing, and dental services.
- Part D may be included in Part C.
- The plan may include coverage for home modification and transportation to/from doctor appointments.
- Part C can be a good option for people with a limited income.
- The plan rules can change each year so you’ll want to review it every fall.
TIP: If you are shopping for a new plan and want free quotes and to compare or enroll in a Medicare Advantage plan in your area. This U.S. News World Report offers a list of the Best Medicare Plan Insurance Companies 2023.
What is Medicare Part D?
Medicare Part D helps cover the cost of prescription drugs, including many recommended shots and vaccines. (Just remember the word “drugs” begins with “D”.)
Here are some key things to know about Part D:
- Plans are offered by private companies.
- Anyone who has Part A or Part B is eligible for Medicare Part D.
- Joining a Part D plan is voluntary and you pay an extra monthly premium for the coverage.
- Part D benefits are available as a standalone plan added to Plan A and B.
- Part D may be included in Part C.
- TIP: Since insurance companies have different prescription drugs on their approved list, it’s important to check to make sure your current prescriptions are covered under the plan you are selecting.
We haven’t gotten to Medigap yet, but if you already know you want help from someone to sort out your Medicare coverage, you can call your State Health Insurance Program (SHIP) for free and unbiased advice about Medicare programs.
What is Medigap? (aka Plan G or Plan K)
Medigap is extra insurance you can buy from a private company that helps pay for things like your deductibles and copays. Basically it fills the gap between your Medicare benefit and what you’d pay out of pocket that is normally the percentage of your share. Here are some key things to know about Medigap:
- It is purchased from a private insurance company.
- Medigap may be good for those with chronic illnesses or those who need expensive medical procedures.
- The Medigap monthly premium is in addition to the monthly Part B premium that you pay to Medicare.
- Medigap plans cost more than Part C plans because they are more comprehensive.
- Medigap plans allow you freedom of choice in your medical care. You can see any physician or healthcare provider that participates in Medicare (nearly 900,000 providers across the nation).
- There are no networks and no referral needed nor are you required to choose a Primary Care Physician.
- To sign up for Medigap, you must be enrolled in both Medicare Parts A and B.
- Medigap policies do not include Part D, so you will purchase your drug plan separately.
- More information about Medigap can be found in the Centers for Medicare & Medicaid Services Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
- You can buy a Medigap policy from any insurance company that is licensed in your state to sell one.
- FYI: Medicare beneficiaries who are also eligible for Medicaid do not need Medigap insurance since Medicaid will cover the cost of their health care expenses.
Finally, what is the difference between Medicare and Medicaid?
These two terms are so similar it’s easy to confuse them! Here is some help defining them and keeping them straight.
Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.
- Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.
- Medicaid is a state and federal program that provides health coverage if you have a very low income.
If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs.
Make sure you remember the difference between the terms Medicare and Medicaid* since they are very easy to confuse. Try this trick to help…
Medicaid: Think of how it ends in “aid”. That will help you remember that it has to do with “financial AID”. *Medicaid is called Medi-Cal in California
Medicare: Think of how it ends in “care”. That will help you remember that it has to do with on-going “health CARE”
As always, if you want help making sense of any of this, contact Ways & Wane at firstname.lastname@example.org!
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