SeniorChoices NW is a subsidiary of Modern Insurance Marketing, Inc., dedicated to serving the needs of Oregon and Washington residents since 1981. As a leading independent insurance agency in the Northwest, we represent most of the major Medicare Advantage and Medicare Supplement plans offered in the region.
Medicare was established in 1965 and is a U.S. Government Administered Health Insurance Program for:
Most people become eligible the month they turn 65. The easiest way to apply is directly thru the Social Security website at www.socialsecurity.gov but you can also go into your local Social Security office.
This year from October 15 to December 7 you will be able to change your plan if you are on a Medicare Advantage Plan. There are a few other special enrollment periods throughout the year so please call us to see if you are eligible.
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Insurance companies can only sell you a “standardized” Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily.
You may be able to choose up to 11 different standardized Medigap policies (Medigap Plans A, B, C, D, F, High Deductible F, G, K, L, M & N). Medigap policies must follow Federal and State laws. These laws protect you. A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.” Each plan has a different set of basic and extra benefits.
It’s important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A, B, C, D, F, High Deductible F, G, K, L, M & N are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medigap insurance company.
You and your spouse must each buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.
Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.
To get a Medicare prescription drug plan, you must already have Medicare Part A and/or B. There are two ways you can elect prescription drug coverage either on a stand-alone basis or through your medical plan. If you purchase a Medicare Advantage medical plan then in most cases you will need to take the drug plan that goes with that plan. However, if you choose a Medicare Supplement or Medigap plan then you will need to select a stand-alone prescription drug plan since generally these plans do not offer a Part D prescription drug plan.
There are many different plans. Medicare prescription drug plans differ in their costs, the drugs they cover, and the pharmacies they work with. But here's how a basic plan would work.
Each month, you pay a monthly fee -- or premium -- for your Part D prescription drug plan. The base beneficiary premium for 2019 is $33.19. You have to keep paying the Medicare Part B premium, which covers doctor visits, as well.
You may also pay a yearly deductible. Yearly deductible is the amount you pay for your prescriptions before the plan begins to pay. Some plans charge no deductible. The standard deductible is $415 in 2019, although it varies depending on your plan. After you have paid the deductible out of your own pocket, your Medicare Prescription Drug Plan kicks in.
Then, when you buy medications, you pay part of the costs, and your plan covers the rest of the costs. Your share may be a flat fee, called a co-pay, or a percentage of the cost of the drug, called co-insurance.
In many plans, there is a coverage gap after you reach a spending limit. This is the "doughnut hole." After the total cost of your drugs (what you and your insurer paid combined) reaches $3,820 in 2019, Medicare stops paying. Once you’re in the “Doughnut Hole” the drug manufacturer pays 50% of the brand name drug cost and the plan pays 25% leaving you responsible for 25% of the cost. For generic drugs the plan pays 63% of the drug cost and you pay 37%.
Once the amount you have spent on drugs during the whole year gets high enough -- in 2019 the limit is $5,100 -- Medicare starts paying again. When this "catastrophic coverage" kicks in, Medicare pays about 95% of all your prescription drug costs for the rest of the year.
Your deductible and all co-payments paid that year count toward that $5,100 limit. However, your monthly premiums do not.
Keep in mind, many seniors will never need to spend $5,100 because they don't use expensive drugs. Also, not all plans work like this. Plans differ in terms of their deductibles, co-payments, and coverage in the "doughnut hole." This coverage gap is an important consideration when choosing your Medicare Prescription Drug Plan.