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How do I know which option is right for me?
Medicare is complicated. We provided a lot of information in the ‘What is Medicare?’ section to try and simplify it as much as possible. Every person’s situation is different—but when choosing your coverage, it’s helpful to keep in mind there are 3 main options:
Option 1: Original Medicare (Part A and Part B) and a separate prescription drug plan (Part D)
This option provides basic health coverage but has gaps in coverage and no limit to annual spending that could cost you a lot of money. Original Medicare doesn’t provide prescription drug coverage (Part D), so you would need to enroll in a separate prescription drug plan. In general, Original Medicare may not provide enough coverage on its own.
Option 2: Add a Medicare Advantage (Part C) plan that includes prescription drug coverage (Part D)
Signing up for a Medicare Advantage plan (Part C) with prescription drug coverage (Part D) in addition to Original Medicare (Part A and Part B) is one option that provides comprehensive coverage. You have all the benefits of Original Medicare plus coverage for additional benefits to cover the gaps in Original Medicare. Plus, selecting a Medicare Advantage plan that includes prescription drug coverage means you get all your coverage in one plan.
Option 3: Add a Medicare Supplement plan and separate prescription drug plan (Part D)
Signing up for a Medicare Supplement Plan and adding a prescription drug plan (Part D) in addition to Original Medicare also provides comprehensive coverage. However, Medicare Supplement plans are generally more expensive than Medicare Advantage plans. Please note: CarePartners of Connecticut does not offer Medicare Supplement plans.
When you are eligible for Medicare, you have several choices of plan types to consider:
- Original Medicare (does not include prescription drug coverage)
- Medicare Advantage Plan (available with prescription drug coverage)
- Medicare Supplement Plan (does not include prescription drug coverage)
Original Medicare (Part A and Part B)
Original Medicare is basic health insurance provided by the federal government. When you sign up for Medicare Part A and B (when you turn 65 or retire) you are signing up for Original Medicare. Many people think this is the only step of the Medicare process, but there are other options to consider. For many people, relying on just Original Medicare does not provide enough coverage. For example, Original Medicare has deductibles and no limit on out-of-pocket spending. Original Medicare doesn’t cover Part D prescription drugs, routine vision and hearing exams, and certain other services. In order to have enough coverage, you may choose to enroll in an HMO plan or Medicare Supplement plan.
With Original Medicare, there is no limit to the amount you may need to pay.
It’s important to know that if you rely on just Original Medicare (Part A and Part B) there is no limit to the amount you may need to pay for medical costs in a year. Medicare Advantage plans (Part C) have an out-of-pocket maximum that limits the amount you would need to pay for medical costs in a year. Original Medicare doesn’t have this limit.
How to protect yourself from the gaps in Original Medicare
Original Medicare (Part A and Part B) does not provide comprehensive coverage. But you can fill the “gaps” in coverage by:
- Adding a Medicare Advantage Plan (Part C) with prescription drug coverage (Part D) to your Original Medicare (Part A and Part B) coverage.
- Adding a Medicare Supplement Plan and a separate standalone prescription drug plan (Part D) to your Original Medicare (Part A and Part B) coverage.
Medicare Advantage Plans (Part C)
Many people choose to sign up for a Medicare Advantage plan in addition to Original Medicare because it covers everything Original Medicare covers plus additional benefits. Medicare Advantage plans are available with prescription drug coverage, so you can have medical and drug coverage in one plan.
What are the types of Medicare Advantage Plans?
Health Maintenance Organization
Patients select a primary care provider (PCP) from within the network, and referrals to specialists go through your PCP.
Offered by CarePartners of Connecticut
Preferred Provider Organization
No network restrictions or referrals; premiums may be higher.
Offered by CarePartners of Connecticut
The plan determines how much it will pay and how much you must pay for care. Not all providers may accept the plan's payment terms. Also, if your plan has a network, you may pay more to see an out-of-network provider.
Not offered by CarePartners of Connecticut
Why choose a Medicare Advantage Plan?
Medicare Advantage plans typically cover vision, hearing, and health and wellness.
Filling cost gaps
Covers the cost of care that may fall outside the established scope or time frame of Original Medicare.
Our plans offer coordinated care within a network of care providers.
How CarePartners of Connecticut plans cover the gaps
CarePartners of Connecticut Medicare Advantage (Part C) plans provide all the coverage of Original Medicare (Part A and Part B) plus coverage for important additional benefits:
- Out-of-pocket limit to the amount you would have to pay for medical expenses in a year.
- Available with prescription drug coverage so you can have your medical and prescription drug coverage all in one plan.
- Coverage for routine vision and hearing exams, fitness reimbursements, worldwide travel coverage, and more.
- We have both HMO and PPO plans. HMO plans allow you to choose a primary care physician to help coordinate the care you need and make informed decisions about your health. A PPO plan will provide you more freedom to see different doctors but you are responsible for coordinating your care.
- We have thousands of PCPs in our network to choose from and can help you select a PCP if you don’t currently have one.
- Monthly premiums for our Medicare Advantage plans start as low as $0.
Medicare Supplement plans
A Medicare Supplement plan is another type of plan you can sign up for in addition to Original Medicare. Like a Medicare Advantage plan, a Medicare Supplement plan provides coverage for benefits not included with Original Medicare. Generally, Medicare Supplement plans have a higher monthly premium than HMO plans, but you can see any doctor who accepts Medicare. With a Medicare Supplement plan, you need to purchase a separate prescription drug plan if you want prescription drug coverage.
What about prescription drug coverage?
In order to have coverage for prescription drugs you would need to enroll in a Medicare Advantage plan that includes prescription drug coverage or a standalone prescription drug plan. Original Medicare and Medicare Supplement plans don’t provide the option of including prescription drug coverage.
What is the penalty for not adding Part D to my plan?
Medicare determines the amount of the penalty by taking the number of months you delayed adding Part D coverage to your plan and multiplying by 1%. For example, if you go 14 months without coverage, the penalty will be 14%. Then Medicare determines the amount of the average monthly premium for Medicare drug plans in the nation. In 2020 this average premium amount is $32.74. To calculate the monthly penalty, multiply the penalty percentage and the average monthly premium and round it to the nearest 10 cents. In the example here it would be 14% times $32.74, which equals $4.58. This rounds to $4.60. This amount would be added to the monthly premium for someone with a Part D late enrollment penalty.
The penalty is applied to your Medicare Part D premium after your initial enrollment period has ended and you’ve gone 63 consecutive days without either Medicare Part D coverage or some other form of creditable prescription drug coverage (often through an employer or union) that covers the same costs as standard Medicare Part D.
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