Medicare Coverage Options from Associated Benefits Group, Inc. Serving Oregon, Washington and California

 

Affiliations

NAHU
 
 
 

Your Medicare Coverage Choices

With Medicare, you can choose how you get your health and prescription drug coverage. Below are descriptions of your coverage choices.
Original Medicare
Health insurance for people age 65 or older and under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD), run by the Centers for Medicare and Medicaid Services (CMS).
  • Provides coverage for Medicare Part A - Hospital Insurance
  • Provides coverage for Medicare Part B - Medical Insurance
Medicare Supplement
You can purchase a Medicare Supplement (Medigap policy) to help fill in the gaps in Part A and Part B. Medicare Supplement Plans are sold by private insurance companies and are designed to complement Medicare by filling the gaps. Medicare Supplement Plans are standard in design meaning all plans A through N provide the same benefits from company to company. Only the premiums will differ from company to company. IE: Plan F is the same regardless of the company offering the plan. These plans were "Modernized" as of June 1, 2010 and are referred to as the "Modernized Plans".
 
 
  • You can also join a Medicare Prescription Drug Plan (Medicare Part D) to add drug coverage.
For more information please call our office at 800-821-9876 or use our interactive online form
Medicare Advantage Plans (Part C)
Medicare Advantage Plans (MA) are run by private insurance companies approved by and under contract with Medicare (CMS). "Advantage Plans" provide your Part A - Hospital and Part B - Medical insurance coverage. With Medicare Advantage Plans you may pay a monthly premium. Some plans, however, have no monthly premium. In addition, there may be some cost share in the form of co-payments. For example, a $10 co-pay for a doctor visit or $100 per day co-pay for the hospital. Hospital co-pays are limited to a specific number of days, for example 5 days, after which the hospital is paid in full.
Medicare Advantage Plans have an out-of-pocket maximum. Once the out-of-pocket maximum is met all Medicare services are paid in full.
Medicare Advantage Plans may offer extra coverage (Dental and Vision) and prescription drug coverage (MAPD) for an extra cost. Cost for items and services vary by plan. All plans are not available in all areas. If you want Prescription Drug Coverage with a Medicare Advantage Plan you must get it through your plan. The only exception is a Private Fee For Service advantage plan (PFFS). With a PFFS plan you can purchase a "Stand Alone" prescription drug plan. This is the only exception. Keep in mind, once enrolled in a Medicare Advantage Plan you do not need and cannot use a Medicare Supplement (Medigap) policy.
 
 
Medicare Advantage Plans include the following:
 
  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee for Service (PFFS) Plans
 
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)
 
For more information please call our office at 800-821-9876 or use our interactive online form.
Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug (Part D) coverage to everyone with Medicare. You must have Medicare Part A and be eligible for Medicare Part B or have Medicare Part A and B. To get Medicare Prescription Drug Coverage (Part D) you must join a plan run by a private insurance company approved by and under contract with Medicare. Each plan will vary in premium and drugs covered. If you want Medicare drug coverage you must choose a plan that is either in your Medicare Advantage Plan (MAPD) or works with your plan. Such as a standalone prescription drug plan and a Medicare supplement.
 
NOTE: There are specific guidelines pertaining to the purchase of Medicare Prescription Drug Plans.
If you are enrolled in a Medicare Advantage Plan with Prescription Drug Coverage (MAPD) and you complete and submit and enrollment form for a standalone prescription drug plan you will lose your Medicare Advantage Plan and be sent back to Original Medicare and enrolled in the prescription drug plan. This is only one of several variables. Please contact us for more information concerning plan changes. Call 800-821-9876 or use our interactive online form.