Medicare | Medigap | Part D

What are Medicare Advantage Plans?

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage often includes prescription drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPOs)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there are generally extra benefits and lower copayments than with Original Medicare. However, you may have to see doctors that belong to the network or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits they offer.

If you join a Medicare Advantage Plan, any existing Medigap policy will not work, or will replace an existing Medigap policy. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan.

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What is Medigap or Medicare Supplement?

First and most importantly: BOTH OF THESE TERMS MEAN THE SAME THING.

A Medigap/Medicare Supplement policy is health insurance sold by private companies to fill the "gaps" in Original Medicare coverage. If you have Original Medicare (Part A and B only) and a Medicare Supplement policy, Medicare pays first on your medical claims and the Medicare Supplement pays second. Medicare pays 80% of the allowed amount of the medical service and the Supplemental insurance pays 20%.

Medicare Supplement plans are 'standardized' by the Center for Medicare Services. There are several plans to choose from, letters A through N. Medigap must follow Federal and State laws. Each plan (Plan A through Plan N) has a different set of benefits, which are mandated by the government. Our agents can help you compare these letter plans side by side to find the best one for your needs.

It's important to compare Medicare Supplement providers because costs can vary. For example, the benefits in any Medigap Plan G is the same with all carriers, but costs may be different. Each company decides which plans they wish to sell in Oregon. Our agents will go over the benefits of a Supplemental plan, and why it works well for certain segments of the Medicare population.

Generally, when you buy a Medigap policy, you must have Parts A & B. You will continue to pay a Part B premium, and then pay an additional premium to the insurance company. It is also a best practice to add a stand-alone Part D drug plan.

In Oregon, you may change from one company's supplement to another company once a year. The timeframe to make changes includes the month before, the month of, and the month after your birthday. Many Medicare Supplement policyholders switch insurance carriers every year or two to stay with the best rates.

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What is Medicare Part D?

Part D is prescription drug coverage. Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.

You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may pay a penalty. If you didn't join when you were first eligible, your next opportunity to join will be from October 15, 2024 to December 7, 2024.

There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Like other insurance, you will generally pay a monthly premium, which varies by plan, and has a yearly deductible. You will also pay a part of the cost of your prescriptions, called a copayment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium.

There is extra help for people with limited income and resources. If you qualify for extra help, Medicare will pay for almost all of your prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting www.socialsecurity.gov on the web.

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