Medicare Parts C and D/MediGap
Medicare Advantage, Prescription Drugs and Supplement Plans: Medigap
The recent blog about Medicare parts A and B discussed how to sign up for Medicare and when to delay, along with the general coverage of parts A and B. These are known as the Original Medicare, run by the Federal government. But private health insurance companies are able to offer Medicare supplement plans, with Part C (known as Medicare Advantage) and Part D, relating to prescription drugs. Another option is enrolling in Medigap (more letters!), which covers health conditions that Medicare may not.
Signing Up For Medicare Parts C and D
After enrolling in original Medicare, you can only sign up for Parts C and D through private health insurance. Part C is also known as Medicare Advantage and covers A, B, and sometimes D. In some cases, your employer or company may offer this as part of your employment benefits; but others may have to go down a private route for access.
It’s important to note that if you decide to enroll in Medicare Advantage; you still have full access to the original Medicare benefits in Parts A and B.
Coverage of Medicare Advantage and Prescription Drugs
There are many choices available for those seeking medical coverage. You can select original Medicare (just parts A and B) or buy a plan that incorporates parts A, B, and D called Part C.
Part C involves an “all in one” care model and may encompass your vision and dental care alongside emergency medical care and visits to the doctors. There are a range of plans to choose from, with some including more lifestyle-focused benefits such as gym memberships and fitness club access. However, due to the range of plans available, you should consider how your plan affects:
Out of pocket expenses
Referrals to specialists
Network coverage (including limitations on the admittance into certain facilities)
Part D is for prescription drugs. Access to this requires a monthly premium, unless it is included in your Medicare Advantage Plan. For part D, an insurance company will decide which drugs are included, but the federal government is able to rule out certain drugs that Medicare will never have to pay.
Medigap
Medigap plans are supplemental insurance plans for things that your original Medicare insurance doesn’t cover. Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters.1
Medigap has 10 plans - also listed by letters just to make it more confusing, right? Each covers different things and can vary by state. Visit this link to learn more about each.
Unfortunately, Medigap plans do have certain limits:
They do not cover prescriptions
You cannot enroll in Medigap if you have Medicare Advantage
Not all companies offer the 10 standard policies
To get more information on whether Medicare will cover what you need, it’s best to talk to a specialist. Unfortunately, Medicare coverage is subject to change between states, as local coverage and services are decided by different local companies. If you’d like to discuss Medicare options, schedule a call with me here. We can also help set you up with an independent Medicare agent to help sort through all the Parts and Plans.