Medicare Supplements - Prescription Drug Benefits - Medicare Advantage Plans   

Original Medicare Part A & Part B Insurance 

Original Medicare Part A& Part B

is a health insurance program for:

  • people age 65 or older,

  • people under age 65 with certain disabilities, and

  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Cost Sharing – Original Medicare A&B is considered a federally funded health plan structured with a benefit period deductible, co-pays, and coinsurance benefits. With no maximum out of pocket expense stop-loss, Original Medicare insurance is structured as a share of the cost; 80/20 plan. When a benefit period deductible is met, 80% of the remaining cost is covered by Medicare. 20% of the remaining balance is covered by the Medicare Beneficiary. 

 Original Medicare A&B Benefits include:

Medicare Part A ( Hospital Coverage) Helps pay for the cost of inpatient hospital care, skilled nursing-home health care, and hospice care.   While employed, if you have paid into the Medicare tax over a 10 year period, Medicare Part A (Hospital Coverage) is free.  Original Medicare Part A deductibles, hospital stay benefit periods, copays, and coinsurance are the financial responsibility of the Medicare member.  

 

Medicare Part B ( Doctors Visits)  - This is also your outpatient services benefit for treatment at hospitals, clinics, lab tests, x-rays, primary care and specialist visits, some skilled nursing, and home health care. There is a monthly premium that you must maintain in order to keep Medicare Part B coverage. ( Your income level determines how much you'll pay via your Medicare Part B monthly premium) 

 Once you turn 65 you will have 90 days to elect to enroll in Medicare Part B.  Failure to do so can result in adding a penalty (fee) to your initial Medicare Part B monthly premium.  If you are employed and have what is considered (credible health insurance ) you can delay enrolling in Medicare Part B. 

Medicare Part  C- Medicare Advantage 

Medicare Part c - Medicare Advantage

Private Insurance Plans

In 1990- Those eligible for Medicare coverage had more options via the private market through Medicare Part C - Medicare Advantage.  Orignially known as "Medicare Choice" the new private options offered attractive add-on benefits such as prescription drudge coverage 

Medicare Supplements – Commonly known as  "Medi-Gap" insurance plans, not to be confused with Medicare Advantage plans, help pay for some or all costs, Original Medicare A&B insurance does not pay for. e.g deductibles, co-pays, and co-insurance.  As an added benefit with a Medicare Supplement, you're able to see any doctor or specialist without a referral as long as they accept the terms and conditions of Medicare.  Unfortunately, Medi-Gap plans do not cover prescriptions and you would need to purchase a separate Prescription drug plan in addition to purchasing a Medi-Gap plan in order to cover your hospital, medical and prescription needs.

 

Part C-Medicare Advantage Plans -Combine your Medicare Part A (hospital) and Medicare Part B (medical ) and Part D (prescription) benefits into one insurance plan.  Offered by private insurance companies, most  Medicare Advantage plans have $0.00 monthly premiums with an annual Out-Of-Pocket share of cost limit, designed to protect you financially.  With a Medicare Advantage plan, you select a primary doctor who manages your care with access to specialists and hospitals that participate within the same medical group.  Structured as either an HMO, PPO, POS (Point of sale), or an SNP (special needs plan), many plans offer additional benefits not offered by Original Medicare., for example, but not limited to:  Vision, Dental, Hearing Aid benefits, and Gym Memberships. 

Medicare Part D-  Also known as a Medicare prescription drug benefit, offered with an HMO, PPO, or as a Stand-Along plan, is considered a federal-government program that helps subsidize the costs of prescription drugs.   Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary) which are structured/priced in Tiers which determines the covered prescriptions cost/savings. ** Not all Formularies are structured the same** Other components of a Part D plan include a yearly deductible, an annual;  initial coverage limit, a true-out of pocket maximum, and catastrophic coverage cost. 

With so many options and uncertainty about Original Medicare, Medicare Supplements, Medicare Advantage, and Medicare Part D benefits, rest assured Delington consultants use an efficient consultation along with an effective educational approach while helping Medicare-eligible members gain a better understanding of their Medicare Advantage options, Medicare Supplement and Prescription Drug Plan benefits and how those plans work in correlation with the Original Medicare Part A & Part B health plan. 

 

Annually trained and certified in all premier Medicare Advantage, Medicare Supplement, and Prescription plan options available in the Northern and Southern California regions, you can trust that a Delington consultant has maintained his / her's state-required license as well as their mandatory annual Center for Medicare Services (CMS): product training and certifications while providing quality guidance to their Medicare-eligible clients as their post-service benefits advocate.

 

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Office: 1-800-705-0723  

Email:  info@delington.com

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