PRESCRIPTION DRUG COVERAGE

Everything You Need To Know.

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Choosing the right Medicare plan can be stressful. We are here to offer the best solutions for you. The medicare maze is confusing especially with all the items you receive in the mail, phone calls, and the advertisements you see on television. Let us help you navigate through the in's and out's of Medicare.

Most people become eligible for Medicare when turning 65. If you are already taking Social Security benefits when you turn 65, then you automatically get Part A and Part B starting the first day of the month you turn 65 (if your birthday is on the first day of the month, Part A and B will start the first day of the prior month). You'll get your Medicare card in the mail 3 months before your 65th birthday. If you are not receiving retirement benefits from Social Security or the RRB, you must enroll to get Medicare. Some people who are under 65 become eligible for Medicare on the basis of disability. If you are under 65 and disabled, you will automatically get Part A and B after receiving disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You'll get your Medicare card in the mail 3 months before your 25th month of disability benefits. If you have ALS (Lou Gehrig's disease), you'll get Part A and B automatically the month your Social Security disability benefits begin. If you have End-Stage Renal Disease (ESRD) and you want Medicare, you'll need to sign up.

PART A - HOSPITAL INSURANCE

Part A covers hospitalization (after a deductible), some inpatient care in skilled nursing facilities, hospice, and other inpatient needs. Some home health care is also covered by Part A.

PART C - MEDICARE ADVANTAGE PLAN

These plans are provided through private insurance companies approved by Medicare. These plans may provide additional benefits than found in Original Medicare with low premiums and co-pays. For example, additional benefits may include coverage for a comprehensive routine annual physical exams, dental, vision, routine foot care, and gym memberships. Plans include an out-of-pocket annual maximum to protect a person from catastrophic illness. Medicare Advantage plans are available with and without prescription drug coverage, Part D.

PART B - MEDICAL INSURANCE

Some of the benefits of Part B are medically necessary doctor services, outpatient surgery, physical therapy, home health care, medical equipment, and other medically necessary benefits.

PART D - PRESCRIPTION COVERAGE

Part D of Medicare provides outpatient prescription drug coverage. It can be purchased as a standalone program with a separate premium or can be included in a Medicare Advantage plan. Plans are offered by private insurance companies and vary in price and benefit design. The drugs included on their approved drug list called formularies are subject to minimum federal requirements. You can choose from many options to find the drug plan that is best suited to your needs.

MOUNTAIN MEDICARE OFFERS INDIVIDUALIZED SOLUTIONS, EDUCATION, AND PRODUCTS FOR MEDICARE BENEFICIARIES. QUALITY COVERAGE, PERSONALIZED SERVICE, AND HIGHLY TRAINED STAFF.

ORIGINAL MEDICARE CONSISTS OF PART A (HOSPITAL COVERAGE) AND PART B (PHYSICIAN COVERAGE).

Part A: Most people get premium-free Part A. If you buy Part A, you’ll pay a monthly premium. You pay a $1,556 inpatient hospital deductible for each benefit period. A benefit period begins the day you’re admitted and ends when you haven’t received any inpatient hospital care for 60 days in a row. If you go into a hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

Part B: The standard Part B premium is $233 (more if you make over $88,000/yr). However, most people who get Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015, which is $170.10/month. You pay $203 per year for your Part B deductible. Once the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services.There’s no limit for what you pay out-of-pocket.

Part D: Medicare Prescription Drug Plans (PDPs) add drug coverage to Original Medicare. To get Medicare prescription drug coverage, you must join a plan offered by a Medicare-approved private insurance company. If you don’t join a Medicare Prescription Plan when you are first eligible, you may have to pay a late enrollment penalty. Each plan can vary in cost and specific drugs covered, but the deductible cannot exceed $480 in 2022. Some plans may not have a deductible.

ORIGINAL MEDICARE + SUPPLEMENT (MEDI-GAP) + PART D

Medigap policies are sold by private insurance companies and help pay for some of the out-of-pocket costs (“gaps”) that Original Medicare doesn’t cover. Medigap policies don’t pay your Medicare premiums (such as the Part B premium), but they may cover the Original Medicare co-insurance, co-payments, 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. you have to pay a monthly premium for a Medicagp policy.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of Medicare-approved amounts for covered health care costs and then your Medigap policy will pay its share.

These plans are regulated by the government and each policy must offer the same basic benefits, no matter which insurance company sells it. Some may offer additional benefits.

There are no provider networks. You can see any doctor that accepts Medicare (no referrals needed).

There are certain guaranteed issue rights. During these periods, an insurance company can’t refuse to sell you a policy or charge you more because of your health. When applying outside of a guaranteed issue right, you will go through underwriting.

New Medigap policies do not include prescription coverage. To get Medicare prescription drug coverage, you must join a separate stand-alone Medicare Prescription Drug Plan (PDP).

ORIGINAL MEDICARE CONSISTS OF PART A (HOSPITAL COVERAGE) AND PART B (PHYSICIAN COVERAGE).

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Also known as “Part C” or “MA Plans,” Medicare Advantage Plans are offered by Medicare-approved private insurance companies.

You must continue to pay your Medicare Part B premium.

You’ll get your Medicare Part A and Part B coverage from the plan and not Original Medicare. Medicare Advantage Plans may also offer extra coverage, like vision, hearing, dental, and other health and wellness programs.

In addition to paying for your Part B premium, you might also have to pay a monthly premium for the Medicare Advantage Plan.

You’ll generally get your services from a plan’s network of providers. All Medicare Advantage Plans offer emergency and urgent care coverage.

In a Health Maintenance Organization (HMO) plan type, you can only go to doctors, other health care providers, or hospitals in the plan’s network except in an urgent or emergency situation. You must select a primary care physician (PCP) and may need to get a referral from your PCP for tests or to see other doctors or specialists.

In a Preferred Provide Organization (PPO) plan type, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside the plan’s network.

Most Medicare Advantage plans include Medicare prescription drug coverage (Part D). These plans are called Medicare Advantage Prescription Drug Plans (MAPDs).

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“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”

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