Medicare

Florida Medicare Insurance Agent

The insurance agents at Affordable Health & Life Insurance are well educated on the complexities of enrolling in Medicare. We are constantly studying and researching the changes in the health insurance marketplace and can help you pick the best plan to fit your needs.

When can I enroll in Medicare?

Medicare

You become eligible to enroll in Medicare 3 months prior to your 65th birthday. This period is called the Initial Enrollment Period. It is essential to enroll in Medicare during the Initial Enrollment Period because there is no underwriting requirement and you automatically will qualify for coverage regardless of your pre-existing health conditions.

What does Medicare cover?

Doctors

Medicare Part A covers hospital, skilled nursing facilities, hospice and home health services. Click here to see a chart detailing the coverages and out-of-pocket expenses associated with Medicare Part A.

Medicare Part B covers outpatient medical treatment such as doctors visits, lab tests and other services. Click here to see a chart detailing the coverages and out-of-pocket expenses associated with Medicare Part B.

Medicare Supplement Plans covers all expenses that are not covered by Medicare Part A & B. Medicare Supplement Plans are the gold standard when it comes ensuring people over the age of 65 will not have to come out of pocket to pay for their medical treatment. When you buy a Medicare Supplement Plan, you are still enrolled in original Medicare Part A & B. A great benefit of Medicare Supplement plans is that you can see any doctor that accepts Medicare.

Medicare Part C, commonly known as Medicare Advantage Plan, is offered by private insurance companies and replace the coverage’s offered by Medicare Part A & B. The Medicare Advantage Plans typically offer the same, and more, benefits as compared to original Medicare Parts A & B which may include prescription drug coverage’s, fitness programs, routine vision, dental and some hearing aids as well. It is very common for Medicare recipients to enroll in Medicare Advantage Plans as opposed to staying with Original Medicare.

Medicare Part D covers prescription medication. Medicare Part D is usually purchased by people who enroll in original Medicare, Part A & B. People who enroll in Medicare Part C (Medicare Advantage Plans) usually obtain coverage for the prescription medication without the need to enroll in Medicare Part D.

How Much does Medicare Cost?

Medicare Part A usually cost $0.00.

Medicare Part B usually cost $134.00 per month. People who have low income and little assets may obtain assistance using Medicaid for their Part B coverage.

Medicare Supplement Plans vary in cost depending upon which company you choose and your age at the time of enrolling in the plan. The younger you are when you enroll in a Medicare Supplement Plan, the lower your monthly premium. Further, your premium will remain the same for the rest of your life.

Medicare Part C (Medicare Advantage Plans) usually cost $0.00 so long as the individual is enrolled in Medicare Part B.

Medicare Part D varies in price but typically start at $10.00 per month. People who have low income and little assets may obtain assistance using Medicaid for their Part D coverage.

Medicare Advantage Plans

Vaccine - Preventive Medicine

Vaccine – Preventive Medicine

Just like private health insurance, there are many types of Medicare Advantage Plans. Each plan offers different benefits and will appeal to a variety of people dependent upon their health concerns. Further, similar to private health insurance, Medicare Health Plans are offered as HMO, PPO, PFFS, MSA & SNP plans.

How To Compare Medicare Advantage Plans

Medicare & Medicaid rates all Medicare Advantage and drug plans each year based on quality, performance, and customer service. They are rated on a scale of 1-5, with a 5-star rating being excellent and a 1-star rating being poor.

HMO Medicare Advantage Plans

An HMO (Health Management Organization) Medicare Advantage Plan provides its members with a network of doctors, hospitals and other medical providers from which they are permitted to get care. The plan members must seek medical treatment within their plan network. The only exception is the plan member is permitted to seek emergency medical treatment outside of their plan network.

Once enrolled in an HMO Medicare Advantage Plan, the member will select their primary care physician who will manage the member’s medical care. If the member requires medical treatment from a specialist the primary care physician will coordinate appointments among a network of specialist. The plan member may select any primary care physician of their choosing so long as the primary care physician is within the HMO network.

The major benefits of an HMO as compared to a PPO is the member usually has lower out of pocket expenses, deductibles and co-payments.

PPO Medicare Advantage Plans

A PPO (Preferred Provider Network) Medicare Advantage Plan allows members to seek medical treatment from both in-network and out-of-network medical providers. Some medical expenses incurred by out-of-network providers may be covered by the plan-although at a lower rate than the in-network medical providers. This gives the member more flexibility in selecting their medical care. Additionally, members of PPO Medicare Advantage Plans may seek medical treatment from a specialty medical provider without first obtaining approval from their primary care physician.

PFFS Medicare Advantage Plans

A PFFS (Private Fee For Service) Medicare Advantage Plans allows members to obtain treatment from any medical provider who accepts Original Medicare. The PFFS Medicare Advantage Plans set a fee schedule on how much the doctor is permitted to charge and what part of the charge will be covered by the plan. However, these plans are not popular because this is no requirement upon the medical provider to treat members covered by these types of plans. If the medical provider feels the fee schedule is too low they may choose not to provide treatment to the plan member.

MSA Medicare Advantage Plans

A MSA (Medical Savings Account) Advantage Plan is a high deductible health plan. These plans are similar to traditional HSA (Health Savings Accounts) or High Deductible Health Insurance Plans. The insurance will kick in after a high deductible is met.

SNP Medicare Advantage Plans

A SNP (Special Needs Plan) Medicare Advantage Plan is reserved for people who have unique health issues. These plans can be in the form of either HMO or PPO Plans. Example of conditions that may qualify for SNP Medicare Advantage Plans include nursing home residents, Medicaid recipients or other people with disabling health conditions.

Medicare Prescription Drug Plans

Prescription and pills

Medicare Part D is also referred to as a prescription drug plan. Medicare Part D is designed to subsidize the cost of prescription medication. Medicare Part D Plans are designed for people who are enrolled in original Medicare Part A & B. Those people who have opted to enroll in a private plan, Medicare Part C (Medicare Advantage Plan), will get their prescription drugs covered under their Medicare Part C Plan.

How Much Does Medicare Part D Cost?

Medicare Part D Plans vary in price but start at $10.00 per month. If you have limited income and assets you may qualify for a subsidy.

  • Drug Tier (i.e. generics, name brand, exclusivity)
  • Location of your pharmacy (i.e. local pharmacy v. mail order)
  • The amount of money the enrollee has paid out-of-pocket during the year (4 stages)

What are the four stages of Medicare Part D

Medicare Part D subsidizes enrollees’ cost of prescription medication based the amount of money the enrollee has paid out-of-pocket throughout the year. There are four main stages which are detailed below. The out-of-pocket limits are calculated on an annual basis and reset each year.

  • Deductible: Enrollees pay 100% of their prescription drug cost up to the first $400 for specialty medication. However, the deductible is usually waived for most generic and widely sold prescription drugs.
  • Initial Coverage: After reaching their $400 deductible, enrollees will pay 25% of their prescription drug cost until their total out of pocket expenses reach $1,225.
  • Coverage Gap: After exhausting their initial coverage, enrollees will enter what is known as the “Donut Hole” where prescription drug coverage is reduced. Enrollees be required to pay 51% of the cost of their generic drugs and 40% of the cost brand-named drugs until the enrollee’s total out of pocket expenses have reached $4,950.00.
  • Catastrophic Coverage: After exiting the coverage gap and reaching the annual out-of-pocket threshold of $4,950.00, enrollees will only be required pay 5% of their prescription drugs or $3.30 for generic drugs—which ever is greater.

How do I now if my drugs are covered by Medicare Part D?

All PDP plans have a formulary which will list all the drugs they cover and how much they pay towards the drug. All formulary’s must be approved by CMS.

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