What are my options if I have Medicare?
Medicare Supplement:
Original Medicare with a Medicare Supplement and No Part D plan means that a Medicare Beneficiary is receiving Part A and Part B of Medicare and purchases a Medicare Supplement (Medigap Plan) to Supplement the Original Medicare Benefits and does not purchase a Medicare Part D plan for Prescription Drug coverage.
Is this option right for me?
- If you have other supplementary coverage for Prescription Drug coverage (for example, VA Drug benefits), this could be a good choice.
- If you prefer a fixed premium to reduce financial exposure, this could be a good choice.
- If you are not willing to accept a network less than all Medicare approved providers, this could be a good choice.
Advantages
- Financial Exposure to Part A and Part B cost sharing can be virtually eliminated (depending on the Medicare Supplement plan selected) in exchange for a premium with a fixed cost for the year.
- Medicare Supplement plans are "Guaranteed Renewable" which protects insurability.
- Has the same broad network of Providers and Hospitals that Original Medicare offers.
Disadvantages
- Unlimited financial exposure for Part D Prescription drug expenses.
- Late Enrollment Penalty would apply for Medicare Prescription Drug benefit unless there is other Creditable coverage.
- There is a premium which must be paid for the Medicare Supplement plan.
- In absence of other coverage (for example, employer-sponsored retiree drug coverage, Union-sponsored Retiree drug coverage, Veteran's Administration, etc.), Medicare Beneficiary would be responsible for all outpatient Prescription Drug Costs.
Costs
Cost Sharing would depend on the Medicare Supplement plan you choose. There are 11 plans to choose from: A, B, C, D, F, G, K, L, M, N and High Deductible F. Premiums for each plan will vary based on the insurance company you choose.
Medicare Supplement and Part D:
Original Medicare with a Medicare Supplement and Part D plan means that a Medicare Beneficiary is receiving Part A and Part B of Medicare, purchases a Medicare Supplement (Medigap Plan) to Supplement the Original Medicare Benefits and purchases a Medicare Part D plan for Prescription Drug coverage.
Is this option right for me?
- If you do not have other supplementary coverage for Prescription Drug coverage, this could be a good choice.
- If you prefer a fixed premium to reduce financial exposure, this could be a good choice.
- If you are not willing to accept a network less than all Medicare approved providers, this could be a good choice.
Advantages
- Financial Exposure to Part A and Part B cost sharing can be virtually eliminated (depending on the Medicare Supplement plan selected) in exchange for a premium with a fixed cost for the year.
- Medicare Supplement plans are "Guaranteed Renewable" which protects insurability.
- Has the same broad network of Providers and Hospitals that Original Medicare offers.
- Ability to select a Standalone Medicare Part D plan which is suited to your specific prescription drug needs.
- Coverage for Medicare Prescription Drug Benefits
- Avoids Late Enrollment Penalty (LEP) for Medicare Part D Prescription Drug Benefits.
Disadvantages
- There is a premium which must be paid for the Medicare Supplement plan.
- For those who do not qualify for "Extra Help" paying for their Prescription Drugs, there would be a premium for Part D.
Costs
Cost Sharing would depend on the Medicare Supplement plan you choose. There are 11 plans to choose from: A, B, C, D, F, G, K, L, M, N and High Deductible F. Premiums for each plan will vary based on the insurance company you choose.
PPO with Prescription Drugs:
A Medicare PPO Plan is a Medicare Advantage Plan where a Private Insurance company provides your Medicare Part A and Part B benefits and, in addition, this option includes Medicare Prescription Drug Coverage. In a Medicare PPO Plan, you can get Medical Services from any provider who accepts Medicare. The Medicare PPO has a preferred network of providers "in network" where cost sharing is lower. Other providers are "out of network". Cost sharing is generally higher for "out of network" providers. Premiums will vary depending on the plans available in your area. Depending on the plans available in your area, some of the plans may include Dental, Vision, Hearing, Gym Memberships. Additionally, some plans may include a Maximum out of Pocket which would put a cap on your financial exposure in a calendar year.
Is this option right for me?
- If you like having your drug benefits included in with your other medical services (hospital and doctor), this could be a good choice.
- If you enjoy value added benefits, like hearing, vision, dental, gym memberships, this could be a good choice.
- If you like having care coordination services to assist you with a chronic condition, this could be a good choice.
- If you prefer a lower fixed monthly premium with higher cost sharing when you need to access benefits to a higher fixed monthly premium with lower cost sharing, this could be a good choice.
- If you value the freedom of being able to choose out of network providers in special circumstances, this could be a good choice.
- If you are satisfied with the Provider network for your basic healthcare needs, this could be a good choice.
Advantages
- Financial Exposure to Part A and Part B cost sharing can be capped depending on the specifics of the plans in your area.
- Premium can be lower than a Medicare Supplement depending on the specifics of the plans in your area.
- Freedom to use "out of network" providers at a higher cost share.
- Additional Value Added benefits may be available (like Dental, Vision, Hearing and Gym benefits) depending on the specifics of the plans in your area.
- Drug benefit is integrated into plan, so you only have one card and one plan.
- Limits exposure to cost for Medicare covered Prescription drugs.
- Avoids Late Enrollment Penalty (LEP) for Medicare Part D Prescription Drug Benefits.
Disadvantages
- Unknown Out of Pocket costs depending on your level of utilization of services in the Medicare PPO plan.
- Medicare Advantage plans are not Guaranteed Renewable like Medicare Supplement plans. In addition, the benefits can be changed on a calendar year basis.
- Higher cost sharing to use "out of network" providers.
- You do not have the ability to select a specific drug plan based on your prescription drug needs. You get the prescription drug benefit which is bundled in the plan.
Medicare PPO plan without Prescription Drugs:
