• Tom

The Three Types of Senior Health Plans

In this second of five articles on senior health & prescription drug plans I discuss the three main types of plans: Medicare Advantage Plans, Medicare Supplement Plans & Part D Prescription Drug Plans. I am providing a general summary of each type of plan and I will mention here that for a more detailed explanation of each plan, please contact me for more information. I enjoy working with seniors and I am happy to help! Let's take a look at each plan:

  1. Medicare Advantage Plans: Medicare Advantage Plans (also called 'Part C Plans') include both inpatient & outpatient health benefits PLUS prescription drug coverage. You pay one monthly premium for all of these benefits. Medicare Advantage plans must cover all benefits included in Original Medicare Parts A & B, plus additional benefits such as routine preventive dental care and vision care. (note: Medicare Advantage Plans can include different additional benefits. Please contact me for a list of specific additional benefits for specific Medicare Advantage Plans). Medicare Advantage Plans often have very low monthly premiums, and there are often copays, coinsurance and deductibles you pay for specific medical & prescription drug benefits. The plans also often include an annual out-of-pocket maximum expense benefit that limits total annual expenses you pay out of your own pocket.

  2. Medicare Supplement Plans: (also called 'Medigap' Plans) include both inpatient & outpatient health benefits but they DO NOT include prescription drug coverage. (note: you can add prescription drug coverage to a Medicare Supplement Plan-more on that under #3 below). Medicare Supplement Plans help pay many of the health care costs that Original Medicare doesn't cover including copays, coinsurance and deductibles. Monthly premiums for Medicare Supplement Plans tend to be higher than Medicare Advantage Plans, and only two plans offer an annual out-of-pocket maximum expense benefit. (note: There are ten specific Medicare Supplement Plans that every company must offer the consumer. For specific coverage details on each of these plans please contact my office).

  3. Part D Prescription Drug Plans: Just like the title implies, these plans cover prescription drug benefits ONLY. Many Part D Prescription Drug Plans also include copays, coinsurance and an annual deductible you must pay. Part D Prescription Drug plans all include a drug 'Formulary' that lists each specific medication covered by the plan. There is a monthly premium for these plans and they can be purchased separately as 'stand-alone' Part D Prescription Drug Plans, (in this case they are usually purchased by individuals who are only enrolled in Original Medicare, and they want to add prescription drug coverage), OR they are purchased by individuals enrolled in a Medicare Supplement Plan, who want to add prescription drug coverage.

As I mentioned at the beginning of the article, this is a general summary description of the three types of senior health & prescription drug plans. There is much more detailed information an individual needs to understand before choosing a specific plan. That's what I do and what I enjoy the most. I meet in-person with each individual, I explain every detail of the plans I handle, I answer all of the questions, and enable seniors to then make informed decisions on the specific plan that is right for them.




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