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Finding Medicare insurance can be a daunting task. With all of the changes happening in the health insurance industry, laws regulating health insurance, and the government’s influence on health insurance, you can trust First Family Insurance to guide you into the right Medicare insurance plan that meets your needs and your budget.
Simply enter your information to receive medicare insurance coverage and pricing. If you need assistance, speak with a licensed Medicare insurance agent at 1-800-327-5579.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
There are different parts of medicare that help cover specific services:
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
There are only certain times when people can enroll in Medicare. Depending on the situation, some people may get Medicare automatically, and others need to apply for Medicare. The first time you can enroll is called your Initial Enrollment Period. Your 7-month Initial Enrollment Period usually:
If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.
Each Medicare drug plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. Sometimes, if your prescriber thinks you need a drug that’s on a higher tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of these:
Medicare drug plans may have these coverage rules:
Before your prescriptions are filled, your Medicare drug plan will also perform additional safety checks, like checking for unsafe amounts of opioid pain medications.
Except for vaccines covered under Medicare Part B (Medical Insurance), Medicare drug plans must cover all commercially available vaccines (like the shingles vaccine) when medically necessary to prevent illness.
In most cases, the prescription drugs you get in a hospital outpatient setting, like an emergency department or during observation services, aren’t covered by Part B. These are sometimes called “self-administered drugs” that you would normally take on your own. Your Medicare drug plan may cover these drugs under certain circumstances.
You’ll likely need to pay out-of-pocket for these drugs and submit a claim to your drug plan for a refund. Or, if you get a bill for self-administered drugs you got in a doctor’s office, call your Medicare drug plan for more information. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name.
Some people with Medicare get their prescription drugs by using an “automatic refill” service that automatically delivers prescription drugs when you’re about to run out. Some prescription drug plans weren’t making sure that some customers still wanted or needed a prescription drug and this created waste and unnecessary additional costs for people with Medicare and Part D.
Now, there’s a new policy for mail-order prescriptions. Plans have to get your approval to deliver a prescription (new or refill) unless you ask for the refill or request the new prescription. Some plans may ask you for your approval every year so that they can send you all new prescriptions without asking you before each delivery. Other plans may ask you before each delivery.
This new policy won’t affect refill reminder programs where you go in person to pick up the prescription, and it won’t apply to long-term care pharmacies that give out and deliver prescription drugs. Giving your approval may be a change for you if you’ve always used mail-order in the past and haven’t had the opportunity to confirm that you still need refills.
If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there’s more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer” to pay. In some cases, there may also be a third payer.
If the insurance company doesn’t pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should’ve made.
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Some types of insurance aren’t Medigap plans, they include:
If you decide to drop your entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy—not just your old Medigap policy without the prescription drug coverage. Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
You have to pay a late enrollment penalty when you join a new Medicare drug plan if: