Medical Planning | Kross Insurance Retirement Solutions

Medicare Planning

Medicare Choices

Before you decide on a plan, we want to make sure you have a clear picture of your choices. One of the biggest areas of confusion is the difference between Medicare Supplement Insurance Plans and Medicare Advantage Plans. These two options are not the same, and understanding the distinction can save you from unexpected surprises later. Many people enroll in a Medicare Advantage Plan thinking it works like a Medicare Supplement Insurance Plan—but it doesn’t. Each plan type offers very different benefits, costs, and levels of flexibility. Knowing how they compare will help you make the choice that truly fits your healthcare needs and lifestyle.

MEDICARE SUPPLEMENT PLANS

A Medicare Supplement Insurance Plan is used with original Medicare. Any caregiver that accepts Medicare will take a Medicare Supplement Insurance Plan because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Medicare Supplement Insurance Plans do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement Insurance Plan does not change year to year (although the cost does generally go up the coverage does not change).

MEDICARE ADVANTAGE PLANS

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

MEDICARE RX DRUG PLANS

Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. Each Medicare Prescription 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. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.

Parts of Medicare

MEDICARE PART A

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

MEDICARE PART B

Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers. Outpatient care. Home health care. Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment). Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

MEDICARE PART D

Part D (Drug coverage): Helps cover the cost of prescription drugs. You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.