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Medicare C & D
Medicare C & D
Medicare Part C Benefits: (MA and MAPD Plans)
A Medicare Advantage Plan is another way to get your Medicare coverage. They are offered by private Insurance Companies that are approved by Medicare. They are not a Medicare Supplement. If you join a Medicare Advantage plan you will not be using your Medicare benefits. The plan will cover your Part A, B and most of the time D benefits as well. They must cover all the services that original Medicare covers. Medicare Advantage plans have co-pays and coinsurance with a maximum out of pocket you could pay for the year and usually a network of providers to adhere to, except PPO plans which have out-of-network benefits with higher copays. They do offer additional benefits not covered by Medicare such as: Gym Membership, Nursing Hot Line, Transportation, Over-the-Counter items, Glasses and some Routine or even Comprehensive Dental depending on the plan.
More information: Medicare Advantage Plans
There are 5 different types of Medicare Advantage Plans:
- Private Fee for Service (PFFS) no list of doctors but the doctor can accept the plan from month to month.
- Health Maintenance Organizations (HMO) Referrals required and must adhere to a list of providers except in emergency situations.
- Health Maintenance Organizations-Point of Service (HMO-POS) which do not require referrals.
- Preferred Provider Organizations (PPO) No referrals required, a list of providers, but can go outside the list with higher co-pays.
- Special Need Plans (SNP) Plans for people who have both Medicare and Medicaid
Medicare Part D
Medicare Part D was signed into order by President George W. Bush in 2003 and implemented in 1/2006. Medicare offers prescription drug coverage to everyone. There is a 1% penalty per month for not taking a plan unless you have creditable coverage through another plan, or you qualify for Extra Help. To get prescription drug coverage “PDP” you must join a plan “Insurance Company” that is approved by Medicare to offer the coverage. It is very IMPORTANT that you compare plans every year, because these plans can change, and you could be spending $1000’s more by not comparing. A Medicare Part D plan can be purchased as a standalone policy, or it can be included in a Medicare Advantage Plan. The Cost of a plan is determined by the company you choose and your income. Premiums are between $0.00 and $181.60 per month plus income related charge.
Income Related Monthly Adjustment Amount (IRMAA)
You will pay more for your prescription plan if your income is above the below amounts.
2024
If your yearly income in 2022 (for what you pay in 2024) was | You pay each month (in 2024) | ||
File individual tax return | File joint tax return | File married & separate tax return | |
$103,000 or less | $206,000 or less | $103,000 or less | your plan premium |
above $103,000 up to $129,000 | above $206,000 up to $258,000 | Not applicable | $12.90 + your plan premium |
above $129,000 up to $161,000 | above $258,000 up to $322,000 | Not applicable | $33.3 + your plan premium |
above $161,000 up to $193,000 | above $322,000 up to $386,000 | Not applicable | $53.80 + your plan premium |
above $193,000 and less than $499,000 | above $386,000 and less than $749,999 | above $103,000 and less than $397,000 | $74.20 + your plan premium |
$500,000 or above | $750,000 and above | $397,001 and above | $81.00 + your plan premium |
Medicare Part D Benefits
You will Pay a Deductible between $0.00 – $545.00.
You will then pay a Co-pay of either a % or $ Amount, this will be determined by the company in the form of tiers. Tiers are normally 1-5 The higher the Tier the higher the co-pay.
Once the Actual Cost “what you pay and the insurance company pays” of your prescriptions equals $5030.00 you will enter the Gap or Donut Hole. Then you will pay 25% of Brand and 25% of Generic name meds.
The Catastrophic Level is when the out-of-pocket costs reach $8000.00. Then the maximum you will pay is 0% of the cost of the plan covered prescription.
IMPORTANT: All Insurance Companies have a formulary – which is a list of medications the company will cover and what Tiers the medication will be under. Also, they can have 3 requirements:
1. Quantity Limits
2. Prior Authorization
3. Step Therapy
ALL PRESCRIPTION COMPANIES! If you choose to have your premium deducted from your Social Security or Railroad, check it can take several months for this to begin. The initial deduction may be for several months but then will go on a monthly deduction.
For more information: Prescription Drug Plans
IMPORTANT: These plans also change year to year, so it is important to read your Annual Notice of Change and to compare to make sure you are in the right plan.
Low-Income Subsidy (LIS) – Also called “Extra Help” Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs. Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayment.
** We will Compare your prescription plan only if we also represent your Medicare Supplement or if it is built into a Medicare Advantage Plan. We are unbiased and represent 30 different Health Companies so we can choose the best plan that fits your needs 904-242-8893
Stark & Associates Insurance is a local agency in Boca Raton, Florida, specializing in Life and Health Insurance coverage for individuals and businesses.