Need Medigap, Medicare Advantage, Prescription Drugs, Dental, Or Vision Coverage?
Medicare Advantage (Part C)
Medicare Advantage (MA), also known as Medicare Part C, combines Part A and Part B and is offered by Medicare-Approved private insurance companies. To meet customers preferences and needs, carriers offer many plans varying design and pricing of:
- Additional coverage beyond what is covered by original Medicare such as dental, vision, hearing, additional inpatient days, etc.
- Cost sharing
- Out of pocket limits
- Network aspects for access to care
- Care coordination model
There are many types of MA plans, but HMO and PPO are dominant. A popular feature is the Medicare Advantage with Prescription Drugs coverage (MAPD). To enroll in an MA plan, you must have Part A and Part B, and live in the Plan service area.
Part C Premium
The Part C premium varies by Plan and it depends on how the insurance company redesign the cost sharing, the benefits added, the In-and-Out-of Network cost, etc.
Medicare Prescription Drugs (Part D)
This program offers prescription drug coverage through private insurers approved by CMS. You can have coverage through a standalone plan (PDP) or through and MAPD plan. You must have Medicare Part A and / or Part B to enroll in Part D.
Part D Premium
The Part D monthly premium varies by plan and higher-income consumers may pay more. Similar to Part B, a beneficiary will pay an additional Part D premium based on the Income Related Monthly Adjustment Amount (IRMAA).
Part D Deductible and Coinsurance
The deductible under the standard benefit for 2024 is $545 ($505 in 2023). Plan can design the PDP coverage to lower or eliminate the deductible but cannot charge a deductible more than this amount. For coinsurance there are 3 cost phases to consider:
- Initial phase, which starts after you meet your deductible until the total payment made by you and your health plan reaches $5,030 ($4,660 in 2023). In this phase, you pay 25%
- The gap phase: Even though there is no more gap per say for the beneficiary, the distinction is important for the computation of the True Out of Pocket (TrOOP). During this phase:
- you pay 25% of the drug cost and dispensing fees
- Your payment and the manufacturer discount of 70% on brand name drugs count toward your TrOOP.
- The catastrophic coverage period: For 2024 after your TrOOP reaches $8,000 you don't have to pay a copayment or coinsurance.
Premium and non-covered drugs do not count toward TrOOP.
Part D Late Enrollment Penalty
You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:
- A Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan or another Medicare health plan that offers Medicare prescription drug coverage
- Creditable Prescription Drug Coverage
In general, you’ll have to pay this penalty for as long as you have a Medicare drug plan. The penalty is 1% of the national base beneficiary premium times the number of months you stayed without acceptable prescription drug coverage. For 2024, the national base beneficiary premium is $34.70