DrugInfo

Medicare Supplement and Part D Drug Plans In Plain English

If you are about to turn 65, you, no doubt, have already signed up for Medicare or at least you’ve read the info about signing up. So the first question to resolve is should you get a Medicare supplement plan and prescription coverage from Part D or should you go into a Medicare Advantage plan?

For the sake of this article, let’s assume you already have your Medicare set up. So the next question becomes, now what? Medicare was easy, mostly because there’s only one place you can get it, namely, the federal government. After you have your Medicare in place, however, you’re only a third of the way done. Medicare covers 80% of your hospital and physician fees, but there are still two other health insurance plans you need.

Medicare Supplement Insurance Plans

The first is called Medicare supplement insurance, and it does exactly what its name implies. It supplements your Medicare plan. What that means in plain English is that your Medicare supplement insurance pays the difference between what Medicare pays, which in most cases is 80%, and the total amount of your hospital and doctor bills.

So far it’s all pretty easy to understand, right? Medicare pays 80% and your supplement insurance plan pays the remaining 20%, assuming you choose the right plan. But this is where the major private insurance companies come into the picture and make it as difficult as possible for the average person to understand. Each year they come up with different Medicare supplement plans to choose from, they assign them each a letter of the alphabet so, assumingly, you can tell them apart. IN 2010, for example, at the time of this writing, Medicare supplement plans A through N are available, except for E, H, I, and J, which are no longer available.Medicare Part D Drug Plans

The major private insurance companies offer several part D drug plans to choose from. The difference here from plan to plan is in the amount of your deductable, which can range from no deductable at all to a $310. Your deductable, of course, is the total amount you must spend yourself on prescription drugs before your coverage kicks in. The lower your deductable, the higher the monthly premium you pay. So with zero deductable, you’ll pay the highest monthly premium. There’s also something called gap coverage that you’ll need to understand, because after your coverage kicks in, either at zero or $310, when your total prescription drug cost reaches $2700 per calendar year, the major insurance companies actually stop paying until your total drug cost reaches $4350. Again, these figures are based on 2010 plans at the time of this writing, and so, are subject to change. My insurance agent advised that this will become perfectly clear if you think of the coverage gap as a donut hole, as it’s sometimes called.

What The Major Private Insurance Companies Don’t Want You To Know

The major private insurance companies are not likely to tell you that the government requires each insurance company to offer exactly the same Medicare supplement and Part D drug plans within each specific state.

What this means in plain English is that Medicare supplement plans A through N, for example in Texas, must have exactly the same features from each insurance company. In other words, Plan A from one provider must be exactly the same as plan A from any other provider. Plan B from one provider must be exactly the same as Plan B from any other provider, and so on.

The good news is that if you find supplement plans A through N a bit difficult to understand, at least you’ll only have to understand them once because each letter plan must be exactly the same from one insurance company to the next.

With regard to Part D Drug plans, the same holds true. Each provider offers three Part D drug plans to choose from, sometimes referred to as good, better, and best, but the federal government also requires each of those plans to be exactly the same from one provider to another.

How to Choose the Right Medicare Supplement and Drug Plan

Because each specific plan must be exactly the same from one provider to the next your first step is to choose the best Medicare supplement plan (A-N) and the best Medicare Part D drug plan for your specific needs and situation.

While defining each plan (A-N) goes beyond the scope of this article, I will make a few suggestions of what to look for. Also keep in mind that although the individual plans may change from year to year, the one constant is that whatever Plan A is from one provider, Plan A from any of the others is required to be exactly the same.

Last year, for example, I chose Medicare Supplement Plan F and a $310.00 deductable drug plan. As you’re only able to change plans in a small window of time, which this year is from November 15th through December 31st, it’s important to choose the right plans from the beginning. So far so good with both. My Plan F has actually covered the full 20% in every instance and my drug plan is looking like it was the right choice as well, especially after I met my deductable. Even before, however, my drug plan was getting me discounted prices on non-generic prescription drugs.So, to recap, if each individual plan is exactly the same from one company to another, how do you choose the right insurance company?

First you learn everything you can about each of the individual plans from your independent health insurance agent, which makes choosing the right health insurance agent your first priority. You need a licensed, experienced agent who will take the time to explain the various plans in a way that you can understand.

Next, customer service will vary from company to company, so word of mouth, either good or bad, can help you decide. Because past history is the best predictor of future results, consider past experiences with the claim or customer service department either you or someone you know may have had with any of the major insurance companies.

And finally, now that you know that all plans must be exactly the same from one company to another, why not go with the company that offers the lowest monthly premiums, assuming, of course, that it’s a national brand that you’ve heard of?

In other words, if company A, the one that sends you a mailing every other day for three months before you turn 65 until three months after, charges a lot more than company B for exactly the same coverage, then why not go with company B?

Comments are closed.