HEALTH INSURANCE

Medicare Advantage Plans (Part C)

Medicare Advantage Plans or Part C are insurance plans offered by private companies approved by Medicare.

Important things to know.
• You must continue to pay your Medicare Part B premium unless you have the Medicare Savings Program.
• Use of network health care and pharmacy providers is typically required. Using providers outside of the network may cost you more. In an emergency, you can use any provider.
• A Medicare supplement insurance (Medigap policy) plan is not a Medicare Advantage plan.
• Joining a Medicare Advantage plan may affect your current coverage.
• Members of a Medicare Advantage plan must present their member ID card not their Original Medicare card when receiving hospital / medical / Rx services.
• Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare.
• Medicare Advantage plans must cover all the services that Original Medicare covers and may offer additional benefits.
• Your plan’s Maximum out of Pocket (MOOP) is your safety net that ensures you’ll never pay more than a certain amount out of pocket in a given plan year for covered medical and hospital services.

Medicare Supplement Plans (MediGap Policy)

Medicare Supplement Plans are offered by private insurance companies and available to most individuals who are eligible for Medicare Part A & B. They are sold to supplement Original Medicare in the “gaps” like coinsurance, copayments, and medical deductibles.

Important things to know
• Individuals can see any doctor or hospital as long as they accept Medicare patients.
• Individuals can see a specialist without a referral.
• Coverage will travel with you anywhere in the country
• Part D is not included with a Medicare Supplement Plan.
• Most ancillary benefits are not included with Medicare Supplement Plans. (Dental, Vision, Hearing, Over-The-Counter Items, etc.)
• Medicare Supplement Plan is secondary to Original Medicare, but you must show both cards when receiving hospital / medical services.

Medicare Part D or PDP (Prescription Drug Plan)

Medicare Part D or Prescription Drug Plan helps pay for the costs of prescription drugs. Most people who purchase a stand-alone drug plan, typically purchase it with a Medicare Supplement Plan, which does not include drug coverage.

Important things to know
• Formulary – A formulary is a list of drugs that a plan covers. Each plan has its own formulary. Before you enroll, be sure your drugs are covered.
• Tiered Formulary – Many plans use tiered formularies to group covered drugs. For example:
Tier 1 – Preferred generic drugs
Tier 2 – Generic drugs
Tier 3 – Preferred brand name drugs
Tier 4 – Non-preferred drugs
Tier 5 – Specialty drugs
Tier 6 – Select Care Drugs and the last sentence should say

Some drugs require quantity limits, step therapy or prior authorization.

We do not offer every plan available in your area. Currently we represent eight organizations which offer over 50 products in your area. Please contact Medicare. gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.