Medicare: Your Choices
Original Medicare
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- You can join a stand alone Medicare drug plan to get (required) Medicare drug coverage (Part D)
- You can use any doctor or hospital that accepts Medicare, anywhere in the U.S.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also buy supplemental coverage (Medigap).
Original Medicare does not cover everything!
Supplemental Coverage (Medigap)
Supplemental coverage or Medigap is extra or additional insurance that you can purchase to help pay for services and out-of-pocket costs that Original Medicare does not cover such as deductibles and co-insurance.
Medigap policies are standardized , and in most cases named by letters, ie., Plans A-N. You will need to compare these plans to find which one best fits your needs.
Find policies in your area. Price is the only difference with the same letter sold by different companies.
How do you find the policies in your area? Call TBrown Insurance, with no obligation and no cost to you!
Compare supplement plans here:
Medicare Advantage (Part C)
- Medicare Advantage is a Medicare-approved plans through private insurance company's that offers an alternative to Original Medicare for your health and drug coverage. These plans combine Parts A and B, and usually Part D.
- In most cases, you'll need to use doctors who are in the plan's network.
- Plans may have a lower out-of-pocket costs than Original Medicare.
- Plans may offer extra benefits that Original Medicare doesn't offer - like vision, hearing, and dental services.
Prescription Drug Coverage (Part D)
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Many plans place drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
Example:
Tier 1 - lowest co-payment: preferred generic drugs
Tier 2 - medium co-payment: most generic drugs, some brand name
Tier 3 - higher co-payment: preferred brand name drugs
Tier 4 - higher - highest co-payment: most are brand name drugs, some are specialty
Tier 5 - highest co-payment: specialty drugs
Some plans have a 4 tier system and some may go as high as 6 tiers.
It's Your Choice
We can look at adding a Medicare Supplement Plan to Original Medicare with a stand alone Prescription Drug Plan.
Maybe straight Original Medicare will work for you with a stand alone Prescription Drug Plan.
We can also look at Medicare Advantage Plans that combine the health and, in most cases, the Prescription Drug Plan. MAPD's come with some extra benefits like dental, vision, hearing, over-the-counter drugs and more.
It's your choice but perhaps you need a little help. Speaking to someone to help talk you through this dynamic process is a free service to you. And remember, this is not a call center but an independent agent that will focus on your unique medical and financial needs to help get you the right coverage.
And it doesn't stop there. TBrown Insurance will be there after you choose the right plan to answer any questions you may have. It all starts with a phone call!
Special Needs Plans
Dual Eligible Special Needs Plans (D-SNP's)
Dual Eligible Special Needs Plans (D-SNPs) are health insurance plans that combine Medicare and Medicaid benefits for people who qualify for both. D-SNPs are a type of Medicare Advantage plan. How do D-SNPs work?
- D-SNPs are managed care plans that coordinate Medicare and Medicaid benefits.
- D-SNPs are designed for people who may need more help due to age, disabilities, or health conditions.
- D-SNPs include Part D prescription drug coverage at no extra cost.
- D-SNPs assign a care coordinator to develop a care plan.
**Who can enroll in D-SNPs?
- People who qualify for both Medicare and state Medicaid assistance can enroll in D-SNPs.
- States decide which health plans can offer D-SNPs and may review the specific benefits provided.
How to apply for assistance?
- You can apply for assistance online or by mail.
- You can contact your state's Medicaid program for more information.
***Who can assist you in inquiring about these services? Tracey from TBrown Insurance. Call now or schedule a consultation.
Chronic Eligible Special Needs Plans (C-SNP's)
Chronic Special Needs Plans (C-SNPs) are Medicare Advantage plans designed for individuals with specific, severe or disabling chronic conditions, offering specialized care and benefits tailored to their needs. Here's a more detailed explanation: What are C-SNPs?
- Targeted Care: C-SNPs are a type of Medicare Advantage plan (Part C) that focuses on individuals with chronic health conditions, like diabetes, chronic heart failure, or cardiovascular disorders.
- Specialized Benefits: These plans offer benefits and services tailored to the specific needs of individuals with chronic conditions, potentially including extra support, care management programs, and specialized provider networks.
- Examples of Chronic Conditions: Some conditions that may qualify for a C-SNP include diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders, and end-stage renal disease.
- Eligibility: To enroll in a C-SNP, you must be eligible for Medicare and have a qualifying chronic condition.
- Benefits Beyond Original Medicare: C-SNPs typically offer extra benefits beyond Original Medicare, such as predictable prescription drug coverage, care management programs, and lower specialist copays.
- Care Coordination: C-SNPs often include care coordination services to help manage chronic conditions and improve health outcomes.
- Special Enrollment Period: Individuals with qualifying chronic conditions may be eligible for a special enrollment period to enroll in a C-SNP.