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MA vs. MAPD vs. PDP: What are the differences?

MA vs. MAPD vs. PDP: What are the differences?

If you are enrolling or are already enrolled in Medicare, you might be considering finding a plan with prescription drug coverage if you do not already have one. With Medicare, drug coverage is most commonly found in a Medicare Advantage Plan or a Medicare Part D Prescription Drug Plan. 

But, what are the differences between the plans?

What is MA?

Let’s first discuss what a Medicare Advantage Plan is. Medicare Advantage Plans, also known as Part C, offers the same benefits as Original Medicare. However, Advantage Plans can also offer additional benefits, such as dental, vision, and hearing coverage. 

There are various Advantage Plans available, the most common ones known as HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). With an HMO Plan, you must use the network of providers connected with the plan, unless you are in an emergency and cannot reach a specific provider.

With a PPO Plan, you have the option to use the network of providers or use providers outside of the network. However, if you go outside of the network, keep in mind that you may pay higher copayments and coinsurance.

What is MAPD?

Another added benefit of Medicare Advantage is prescription drug coverage. If a Medicare Advantage Plan offers this coverage, it is known as MAPD. Many MSA and PFFS Plans do not offer prescription drug coverage. However, if you are enrolled in one of these plans, you can still enroll in a Medicare Prescription Drug Plan.

Most of the time, HMO and PPO Plans do cover prescription drugs. However, if you join an HMO or PPO Plan that does not, you cannot enroll in a separate Medicare Prescription Drug Plan.

SNPs always offer prescription drug coverage.

What is PDP?

Medicare Part D is Medicare’s Prescription Drug Plan (PDP). It can be purchased as a standalone plan or with a Medicare Advantage Plan. Every PDP must offer a standard level of coverage, each plan covering at least two drugs in each category and class. If you are enrolled in a PDP that does not offer the specific prescription you are taking, the plan will more than likely have a similar drug available. However, you can always ask for an exception, but it is always best to review the plan’s specific formulary to determine if it offers the coverage that you need before settling on it.

As an independent agent, I will help you select which drug plan will work best for you. To learn more about your prescription drug coverage options, reach out to Joseph Cioffi Insurance today!

Top 5 Things You Should Consider With Life Insurance

Top 5 Things You Should Consider With Life Insurance

If you are considering a life insurance policy, there are several factors you should consider before making the ultimate decision on which plan is best for you. 

Here are the top five things to consider when it comes to choosing a life insurance policy.

Living Benefits

As many may know, life insurance policies offer a death benefit that is paid out to the policyholder’s chosen beneficiaries. However, many may not know that some policies also provide living benefits for the policyholder. 

Some policies accumulate a cash value, which can be borrowed against by the living policyholder. However, think of this as a loan. If you do not pay this amount back before your passing, the death benefit for your beneficiaries will be lower.

Choose Multiple Beneficiaries

Speaking of beneficiaries, it is usually best to choose more than one beneficiary to receive the death benefit. Granted, who your beneficiaries are and how many there are is ultimately up to you. However, if you choose only one primary beneficiary and they precede you in death, who will the death benefit go to?

For this specific reason, it would be best to choose at least two beneficiaries so you can ensure that the benefit will still be given to a trusted and cared-for individual.

Term or Permanent

Before deciding on a policy, you need to consider your health and if it would be best to purchase a term life policy or a permanent life policy. 

Term life insurance is the easiest form of life insurance to qualify for and purchase because it only lasts for a specific time. Many terms last 10, 20, or 30 years, and are best used for policyholders expected to pass within that time frame. 

Permanent life insurance, such as whole or universal, is not designated to a specific term but lasts from the time of purchase to death. To keep the policy active, the premium payments must be paid regularly. It’s also important to note that permanent life insurance policies cost more compared to term life.

DIME Method

To determine how much insurance you need, you can use the DIME method, which stands for Debt, Income, Mortgage, and Education. You will take all the costs that fall under these categories and add them together, giving you the amount you owe, which could ultimately fall into your loved ones’ hands after your passing. 

By following this method, you will have a better understanding of how much insurance you need.

The Earlier, The Better

The cost of life insurance is based on health status and age. The younger and healthier you are, the less expensive a policy will be. As you get older, the more likely you are to develop health problems that will impact the premium payment. To avoid these costly premiums in your old age, consider purchasing a life insurance policy while younger.

For more information regarding life insurance policies, reach out to Joseph Cioffi Insurance today!

Original Medicare vs. Medicare Advantage

Original Medicare vs. Medicare Advantage

As you start your initial enrollment into Medicare, or are currently enrolled and questioning your coverage, you may be wondering if Original Medicare or Medicare Advantage provides the best coverage for the best price. 

While the choice of which plan is best is up to you and your coverage needs, you should still be aware of the similarities and differences between both options.

Overview

Original Medicare consists of two parts: A and B. With Parts A and B, you receive coverage for your inpatient and outpatient costs. Original Medicare also provides coverage for care received in a skilled nursing facility, durable medical equipment, lab tests, and preventive care services.

Medicare Advantage, also known as Part C, is seen as an alternative to Original Medicare. It offers the same benefits and includes extra coverage, such as dental, vision, and hearing coverage. There are several plans offered with Medicare Advantage.

Similarities

Original Medicare and Medicare Advantage are similar in many ways:

  • Both options offer Part A and B coverage
  • Both can provide prescription drug coverage (however, Original Medicare is strictly limited to only cover prescriptions in certain situations, and does not usually include the prescriptions that are taken home)
  • Original Medicare and certain Medicare Advantage Plans give you the choice of any doctor or provider as long as they accept Medicare
  • Original Medicare and certain Medicare Advantage Plans have deductibles
  • Both have coinsurance and copayments as out-of-pocket costs
  • Original Medicare has a premium for Part B as many receive premium-free Part A, and depending on the Medicare Advantage Plan, you may or may not have a premium to pay

Differences

Despite their similarities, there are also several differences:

  • Original Medicare does not offer extra benefits
  • Medicare Advantage Plans offer additional benefits such as coverage for dental, hearing, vision, prescription drugs, fitness memberships, nutritional programs, and more

 

  • Original Medicare offers coverage anywhere in the U.S.
  • Medicare Advantage only covers services if you are within your plan’s service area or need emergent care

 

  • Original Medicare does not have an out-of-pocket maximum
  • Medicare Advantage offers a yearly maximum out-of-pocket spending limit, which varies among each plan

Original Medicare or Medicare Advantage?

While Original Medicare and Medicare Advantage are similar in many ways, they also have differences, which can be a dealbreaker when it comes to deciding on a plan. To determine which plan is right for you, give Joseph Cioffi Insurance a call. I can help you find a plan based on your coverage needs.

Are Medicare Supplements Required?

Are Medicare Supplements Required?

Medicare Supplements are not required when you enroll in Original Medicare. However, for some, the extra coverage might be necessary. Here’s how to know if a Medicare Supplement plan is right for you.

Low-income

Suppose you are in a low-income household and cannot afford the out-of-pocket costs left behind by Medicare. In that case, a Medicare Supplement plan may be worth looking into. Generally, Original Medicare will cover around 80% of your healthcare services, leaving the other 20% as your responsibility. This 20% can include deductibles, coinsurance, and copayments, which may not seem like much to some. However, in a low-income household, these costs can cause substantial financial burdens if they continue to increase. 

For many, Part A is premium-free, but Part B always has a premium. As of 2020, the Part B monthly premium is $144.60, but keep in mind these costs change every year. 

Between the monthly premium and out-of-pocket costs, extra coverage may be necessary.

Serious Health Conditions

If you have serious health conditions that require you to receive extensive healthcare services, out-of-pocket costs can add up very quickly if you don’t have an adequate amount of coverage. This is where a Medicare Supplement plan can come in handy. Instead of worrying about how you will pay these out-of-pocket costs, your primary focus should be on your health. A Medicare Supplement will take care of most, if not all, of the costs for you.

Extensive Travel

If you frequently travel outside of the U.S., it’s important to note that Original Medicare alone does not offer coverage for healthcare services received outside of the country. However, several Medicare Supplement plans do. Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N all cover up to 80% of emergency medical costs outside of the U.S.

However, Plans C and F are no longer available to individuals who were not eligible for Medicare before January 1, 2020.

Which plan is right for you?

There are ten supplement plans to choose from, along with two high-deductible options. Each plan covers a specific portion of these out-of-pocket costs, providing you with financial relief. To determine which Medicare Supplement plan is right for you, give Joseph Cioffi Insurance a call today. I can help you find a plan based on your coverage needs.

What is a Medicare Savings Program?

What is a Medicare Savings Program?

Being enrolled in Medicare insurance can save you from paying large amounts to cover your medical care. However, for some, Medicare premiums can be too much to consider. With a Medicare Savings Program, the state will help you pay your Medicare premiums and possibly any deductibles, coinsurance, or copayments that come with Medicare. 

What are the different types of Medicare Savings Programs?

There are four different programs that you can qualify for:

  • Qualified Medicare Beneficiary (QMB): The QMB program helps cover Part A and Part B premiums, as well as deductibles, coinsurance, and copayments.
  • Specified Low-Income Medicare Beneficiary (SLMB): The SLMB program only helps cover Part B premiums.
  • Qualifying Individual (QI): The QI program also only helps cover Part B premiums.
  • Qualified Disabled and Working Individuals (QDWI): The QDWI program only helps cover Part Premiums.

You should always inform your healthcare provider if you are enrolled in a Medicare Savings Program, especially in the QMB program. You will need to provide proof by showing your Medicare, Medicaid, or QMB card every time you receive care. This should correct any billing issues you may have if you are being charged for deductibles, coinsurance, or copayments.

How can I apply?

All states require you to be eligible or enrolled in Medicare Part A, but still keep in mind that other qualifications, the application process, and required documents vary by state. For example, to be eligible for the QMB program, you need to fall within a certain resource limit, which also varies by state and program. When looking at eligibility, some counted resources include checking accounts, savings accounts, or mutual funds.

In many cases, you may need to provide your Social Security card, Medicare card, birth certificate, proof of address, and proof of income to complete an application. After completing an application, make sure to have a copy made to have evidence of applying. Within 45 days, you should receive a Notice of Action regarding your application status.

It is important to note that if you do qualify for the QMB, SLMB, or QI programs, you can also qualify for the Extra Help program, which helps cover prescription drugs.

If you are on a limited income and are unsure if you qualify for a Medicare Savings Program, reach out to an independent agent at Joseph Cioffi Insurance. I will answer all your Medicare-related questions with integrity, quality, and exceptional service.

Which is better: Term life or Whole life insurance?

Which is better: Term life or Whole life insurance?

By investing in life insurance, you are guaranteed that your loved ones will be financially covered in the event of your passing. It can provide financial stability to pay off any debt, mortgage payments, or other financial obligations that may arise for your beneficiaries.

With different life insurance options available, how do you know if you’re choosing the right policy?

What is term life insurance?

Term life insurance provides coverage for a certain amount of time. If you happen to pass away during that specific timeframe, your policy will provide a payout to your beneficiaries. If you are a beneficiary to someone who has a term life policy, then you will receive a payout. This makes the term life policy have no cash value until the policyholder dies.

It’s also possible for the premium to increase over time.

What to consider before choosing a life insurance policy?

There are several factors to consider when deciding how much life insurance you need, such as:

  • Your age
  • Your current state of health and if you have any concerns for your future wellbeing
  • Your debt amount
  • Your family’s financial needs
  • Your retirement plans

It would be best if you also considered the cost difference between term life and whole life insurance. Because a term life policy does not last throughout your entire lifetime and is not at cash value, you will be paying a smaller premium compared to whole life insurance. Your gender and driving record can also impact what you will pay for these policies. For example, men typically pay more for life insurance because of their shorter life expectancy. If you have had problems in the past regarding your driving history, you may have to pay higher rates. Also, take into consideration that your age and current state of health can impact the premium you pay.