Medicare Plans
Free Consultations for Medicare Plans
By law, we cannot charge any fees for our services. Consultations for Medicare Plans are always no cost and no obligation. We enjoy getting to know our clients and building relationships over time.
Original Medicare
Most people enter Medicare for the first time when they turn 65, although some people become eligible for Medicare prior to age 65 due to disability. We assist clients in obtaining their Medicare card at the appropriate time. When a Medicare beneficiary receives their red, white and blue Medicare card, this is known as Original Medicare. Original Medicare consists of two parts: Part A, Hospital Insurance, and Part B, Medical Insurance. There is NO Annual Out-of-Pocket Maximum with Original Medicare; there are deductibles, co-pays, and co-insurance. Also, Original Medicare DOES NOT cover Prescription Drugs (required by law), Dental, Vision, or Hearing.
Types of Medicare Plans
Medicare Plans are issued by private insurance companies with a Medicare contract. Medicare Plans help with out-of-pocket costs, such as deductibles and co-pays, and limit annual out-of-pocket costs. There are different types of Medicare Plans, such as Medicare Supplement Plans (also known as Medi-Gap Plans), Prescription Drug Plans (PDP), and Medicare Advantage Plans.
Medicare Supplement Plans have standard plan designs with no networks. PDPs have various plan designs, contain a formulary of covered drugs (varies by plan). Medicare Advantage Plans have different plan designs, are typically traditional HMOs or PPOs, often include Extra Benefits such as Dental, Vision, Hearing, etc., and often include Prescription Drugs. Medicare Advantage plans are often referred to as “all in one” Medicare Plans.
Medicare Premiums
Most people with Original Medicare do not pay a premium for Part A and pay a standard premium for Part B. For people who choose Original Medicare only, they are required to purchase a Stand-Alone Drug Plan (PDP), and the premiums vary by plan. For people with Original Medicare who wish to limit their out-of-pocket expense, they have the option to purchase a Medicare Supplement Plan (also known as Medi-Gap) for a separate premium. Medicare Advantage plans typically have the lowest premiums (as low as $0)
When a person receives their Red, White, and Blue Medicare Card, they are known as a Medicare Beneficiary and now have Original Medicare. Original Medicare consists of two parts: Part A Hospital Insurance and Part B Medical Insurance. Original Medicare has no annual out-of-pocket limit, does not cover prescription drugs, and does not cover dental, vision, or hearing. By Federal law, Medicare Beneficiaries are required to have Medicare Part A and Part B as well as Prescription Drug Coverage (Part D). Most people do not pay a premium for Part A, pay a standard premium for Part B, and must obtain Part D privately. Some people continue to work past the age of 65 and are still covered by their company-sponsored health plan. In this case, the person may opt out of Part B, and the company-sponsored health plan may also provide Part D Prescription Drug coverage (known as Credible Drug Coverage). When they contact us, we explain what Part A is, what Part B is, how much they will pay when they visit the doctor or are admitted to the hospital, or whether Dental, Vision, Hearing Aids, etc., are covered.
Most people are confused by common Medicare terms shown on T.V. Commercials, or in printed literature, etc. People want to know the difference between a Medicare Supplement (also known as Medi- Gap), a Medicare Advantage Plan (Part C) and a Prescription Drug Plan (Part D, also known as PDP).
Most people are unfamiliar with what Medicare covers or doesn’t cover, and they want to know if there is any premium cost. Some people want to know if they can stay on their company- sponsored health plan if they continue working past age 65. Federal law requires a Medicare Beneficiary to have Part B and Part D or pay a late-enrollment fee.
We like to work with people prior to reaching age 65 by assisting them in obtaining their Medicare Card. If a person is already drawing Social Security retirement benefits, Social Security will send the person their Medicare card a few months prior to turning 65. If the person is not already drawing Social Security retirement benefits, we assist them in applying for their Medicare Card from Social Security.
When people come to us, they want to fill their gaps from Original Medicare. Medicare Health Plans are offered by private insurance companies with a Medicare contract. We represent most Medicare carriers in Maine, including Martin’s Point Generations Advantage, Aetna, Humana, United Healthcare, Wellcare, and Anthem. We do not charge a fee for our services; we work for you for free! We are paid by our Medicare carrier partners.
There are a wide variety of Medicare Health Plans to choose from, including Medicare Advantage, Medicare Supplement, and Prescription Drug Plans. We conduct a detailed needs analysis and explain all the options in order to put clients into plans that are appropriate for their needs as well as their budget. People often ask if we charge for our services. We never charge a fee and there is no obligation to make a purchase from us. Because we are very thorough in our approach, we typically ask our clients to meet with us at least twice for one to two hours. Some concerns our clients have are whether or not they can continue to see their doctor or specialist, and are their prescription drugs covered. While Medicare Advantage Plans are usually HMOs or PPOs with a network of doctors and hospitals, many carriers have national networks which work well for those who intend to travel. Many Medicare Advantage Plans also offer coverage while outside the U.S. Most Medicare Advantage Plans include Prescription Drug coverage as well as Extra Benefits such as Dental, Vision, Hearing, gym memberships, Over-the-Counter allowance, etc. Many Medicare Advantage plans have very low, or in some cases, $0 premium. Medicare Advantage plans are structured like traditional health plans with co- pays and a fixed, annual, out-of-pocket limit.
Medicare Supplements, on the other hand, do not have a network, and the provider must simply be able to bill Medicare. Medicare Supplements have standardized plan designs from one carrier to another and are designed to pay some or all out-of-pocket expenses. For example, a Medicare Supplement plan N would have a fixed deductible and a lower premium than a Medicare Supplement Plan G which would have a much lower deductible but a higher premium. In other words, the lower the premium, the higher the deductible, or the higher the premium, the lower the deductible. Medicare Supplements are optional to purchase to minimize the out-of-pocket medical expenses of Original Medicare, and cannot be paired with a Medicare Advantage plan; by law, it’s one or the other.
Although the purchase of a Medicare Supplement is not required, they are a means of limiting a person’s out-of-pocket expense.
Obtaining Part D Prescription Drug coverage is required by law, even if you do not not take any prescriptions drugs. Prescription Drug Coverage can be obtained by purchasing a stand-alone Prescription Drug Plan (PDP), or it may be included in a Medicare Advantage plan.
