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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!

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.