Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Medicare.gov: the official U.S. government site for Medicare
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Tier 1 Preferred Generic and Tier 2 Non-preferred Generic drugs will have the same coverage as in the Initial Coverage Limit stage. Therefore, Tier 1 and Tier 2 drugs have the same copays during the Coverage Gap Stage. You will also receive a discount on brand-name drugs and generally pay no more than 45% of the plan’s costs for brand drugs and 58% of the plan’s costs for Tier 5 Specialty Generic drugs until your yearly out-of-pocket drug costs reach $4,850.
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Keep in mind that just as costs can vary by plan, Medicare plans that include prescription drug coverage may also vary when it comes to the specific prescription drugs they cover. An easy way to make sure that your current medications are covered is to check the plan’s formulary (list of covered medications) before enrolling in a Medicare plan that includes prescription drug coverage. Keep in mind that formularies are subject to change. Your Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan will notify you if necessary.
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Skilled Nursing Facility Care Coinsurance: This is a facility that handles the required daily involvement of skilled nursing or rehabilitation staff. Examples of skilled nursing facility care include intravenous injections and physical therapy. Medicare pays all of the first 20 days, all but $152 per day of the 21st through the 100th day of approved costs. Medicare pays nothing after the 100th day. The plans pay all, some or none of the first 100 days deductibles or copays as indicated on the Comparison Chart.
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"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
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Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office.
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