The chart on the previous page outlines various Medigap plans. The cost of Medigap policies can vary widely. Since there can be big differences in the premiums that insurance companies charge for exactly the same coverage, it is important to research your policy options. For information on Medigap policies in your area call 1–800–633–4227 or use the Medigap Policy Finder located at www.medicare.gov/medigap-supplemental-insurance-plans . Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Part C — Medicare Advantage . If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and are approved by Medicare. Medicare Advantage combines the Part A (hospitalization) and Part B (medical insurance) portions of Medicare into a single approved plan that is operated by various private companies usually as either a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO). If you choose Medicare Advantage, you will not need a Medigap policy. However, you must still pay the Part B premium as well as the premium and various co-pays associated with the specific plan. Most Part C plans cover prescription drugs. If they don’t, you may be able to enroll in the Part D Prescription Drug Program discussed below. Under Part C plans, Medicare pays an amount of money every month to the plan provider regardless of whether or not you use the health services. Consequently, the benefit of the Medicare Advantage program is that it combines most health coverage requirements into a single plan which may be cost effective for individuals who require a lot of health care services. The open enrollment period for Medicare Advantage is January 1 through March 31. If you are enrolled in an Advantage plan, you will have a chance to switch to a different one, drop your Advantage plan and sign up for original Medicare instead, or sign up for Part D. Part D — Medicare Prescription Drug Program. This program is designed to reduce the out–of–pocket costs incurred for prescription drugs. Under the program, all Medicare participants are eligible to purchase separate prescription drug coverage from a private insurance company. You can get information on the various plans at www.medicare.gov/plan-compare or by calling 1–800–633– 4227. Payments you make into a Medicare drug plan include: a. Monthly Premium. Most drug plans charge a monthly fee that varies by plan and income level. You pay this in addition to the Part B monthly premium. b. Annual Deductible. This is the amount that you pay for your prescriptions before your plan begins to pay. The maximum deductible a plan may have in 2022 is $480.
c. Copayment/Coinsurance. Once you have satisfied the deductible, you will pay either a copayment or coinsurance for each prescription. A copayment is a set amount for all drugs on a tier while with coinsurance you pay a percentage of the drug price. d. Coverage Gap or “Donut Hole.” Most Medicare drug plans have a temporary limit on what the drug plan will cover for drugs. Once you and your plan have spent $4,430 on covered drugs in 2022, you are in the coverage gap. While in the gap you will pay no more than 25% of the cost for brand-name or generic drugs. e. Catastrophic Coverage. Once you have spent $7,050 out-of-pocket in 2022, you are out of the coverage gap. For the rest of the year you will pay either a coinsurance amount of 5% of the prescription cost, or a small copayment for each prescription, whichever is greater. Enrollment in Part D is voluntary. You may select a prescription drug program at age 65 during the normal Medicare enrollment window (three months before to three months after their birth month). If you do not join a Medicare drug plan when you are first eligible, you can subsequently enroll during the annual delayed enrollment period (October 15 – December 7). However, you may have to pay a late enrollment penalty of 1% of the “national base beneficiary premium” ($33.37 in 2022) times the number of full, uncovered months you were eligible but did not join a Medicare Prescription Drug Plan. Medicare has an initiative that provides extra help for people with limited resources who wish to participate in the Prescription Drug Program. For additional information contact Medicare at 1–800–633–4227. TRICARE For Life. If you have TRICARE coverage and Medicare Part A, then you must enroll in Medicare Part B in order to maintain your TRICARE coverage. For those retired members who are eligible for Medicare, the implementation of the Tricare For Life Program may eliminate the need for private Medigap insurance and prescription drug coverage. Chapter 3 provides more information on the TRICARE For Life program. 12–10. NURSING HOMES. The Medicare website at www.medicare.gov/care-compare provides detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country. Inspection results, staff qualifications and general information is provided for each home. The site also provides a Nursing Home Checklist and a Guide to Choosing a Nursing Home.
CHAPTER 12: SOCIAL SECURITY & MEDICARE
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