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Most Popular Questions
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How Much Do Medicare Advantage Plans Cost?
One of the Medicare plan options you might consider is Medicare Advantage (Medicare Part C). Medicare Advantage gives you the opportunity to get your Medicare Part A and Part B benefits from a private insurance company that contracts with Medicare. One exception is that under a Medicare Advantage plan, you receive hospice benefits directly through Medicare Part A and not through the plan. Most Medicare Advantage plans include prescription drug coverage, and some plans offer extra benefits, like routine dental services. We’ll explore factors that affect what Medicare Advantage plans cost.
What do Medicare Advantage plans cost?
Medicare Advantage plans are available from private insurance companies that contract with Medicare. For the most part, each plan sets its own premiums, deductibles, and other Medicare costs. So the answer to “What do Medicare Advantage plans cost?” will vary among plans.
Here are some of the out-of-pocket Medicare costs you could pay if you have a Medicare Advantage plan (not every plan includes every one of these costs):
- Monthly premium
- Deductible
- Coinsurance or copayment
- Prescription drug “coverage gap” costs
When you’re looking at what Medicare Advantage plans cost, it’s worth noting that every plan has an annual out-of-pocket maximum amount. That means that once you have spent a certain amount of money on costs of medical services within a year, you won’t have to pay anything for covered medical services for the rest of that year. The out-of-pocket maximum amount may differ among Medicare Advantage plans, and may change year to year.
What Medicare Advantage plans cost: some plans have $0 premiums
Did you realize that some Medicare Advantage plans have monthly premiums as low as $0? That’s great to know, but you need to also take into account the other Medicare Advantage plan costs. For example, a Medicare Advantage plan might have a $0 premium, but a high deductible amount, so that you’d have to pay a large deductible before the plan covers any services.
Keep in mind that no matter what Medicare Advantage plan you sign up for, you need to continue paying your Part B premium, along with any premium the plan may have.
It may be a good idea to compare all Medicare Advantage plan costs, not just premium amounts, when you’re shopping for a plan.
According to eHealth research, the average monthly premium for Medicare Advantage plans decreased from $12 to $8 between Q1 2018 and Q1 2019. The popularity of zero-dollar premium Medicare Advantage and Medicare Advantage prescription drug plans contributed to the low average premiums for these products.
What Does Medicare Part D Cover?
According to the Centers for Disease Control and Prevention, almost 50 percent of Americans have used at least one prescription drug in the last 30 days. However, Original Medicare (Medicare Part A and Part B) generally does not cover most prescription drugs you take at home. For most prescription drug coverage you will need Medicare Part D offered by a private insurance company. You can get Medicare Part D through a stand-alone Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage. You can get a stand-alone plan to go along with Original Medicare. Medicare Advantage is another way to get all your Medicare benefits in one plan. (Only hospice care is still covered through Medicare Part A.)
Prescription medications
All Medicare Part D plans don’t necessarily cover the same prescription drugs. Each Medicare prescription drug plan has a list of covered drugs called a formulary. The formulary may change at any time but the plan will notify you when necessary. Most Medicare prescription drug plans place medications on different tiers, with each tier corresponding to a different cost. Prescription drugs on lower tiers generally cost less than those on higher tiers. You can search for a plan that covers the prescription drugs you are currently taking.
Over-the-counter medications
Generally Medicare Part D does not cover over-the-counter medications such as Advil, Benadryl, or Pepto-Bismol. Some Medicare Advantage plans, sometimes referred to as Medicare Part C may cover over-the-counter items as supplemental benefits. . Although, Medicare drugs plans are not required to cover over-the-counter drugs there are some exceptions, some plans may cover them as an added benefit.
Vaccines
Medicare Part D generally covers all commercially available vaccines that are reasonable and necessary to prevent illness. Examples of vaccines the most Part D plans cover include the Tdap vaccine and the shingles vaccine. The only vaccines that Part D generally doesn’t cover are those covered by Medicare Part B, such as the flu vaccine, the hepatitis B vaccine and the pneumococcal vaccine for pneumonia.
Medications excluded from Part D coverage
According the Centers for Medicare and Medicaid Services, certain prescription drugs are excluded from Part D coverage. These include but are not limited to:
- Agents for hair growth
- Agents used for weight loss and weight gain
- Prescription vitamins and minerals
- Over the counter smoking cessation medications
- Barbiturates
- Blood glucose testing strips
Would you like help finding Medicare Prescription Drug coverage ?
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To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
How Much Does Medicare Part D Cost?
Summary: Medicare Part D is the prescription drug coverage “part” of Medicare. It’s optional, and available from private insurance companies that contract with Medicare. It’s important to remember that while you might get enrolled into Medicare Part A and Part B when you’re eligible, you’re generally not automatically enrolled in Part D.
How do you get Medicare Part D?
Before we get into how much Medicare Part D costs, here’s a brief summary on how you get this coverage. You can get Medicare prescription drug coverage in either of these ways:
- As a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare (Part A and/or Part B) coverage
- Included in a Medicare Advantage Prescription Drug plan
How much does Part D coverage cost?
Since private, Medicare-approved insurance companies offer Medicare Prescription Drug Plans, how much Part D costs may vary widely from one plan to another. Some Medicare Part D costs for a stand-alone plan or a Medicare Advantage plan might include:
- A monthly plan premium
- An annual deductible (this amount can be no higher than $435 in 2020
- A coinsurance or copayment for each covered prescription drug.
Please note that not every Medicare Prescription Drug Plan has a monthly premium, and some plans might not have deductibles.
To keep your Medicare Part D costs as low as you can, you might want to ask your plan if there’s a preferred pharmacy it uses, or if you can save money by ordering your medications by mail.
What other Medicare Part D costs should I know about?
Here are some possible Medicare Part D costs that might not affect you, but may be good to know about.
- Late enrollment penalty – Although Medicare Part D is optional, if you don’t sign up for a Medicare Prescription Drug Plan when you’re first eligible, you might pay a late enrollment penalty if you decide to enroll later.
- Coverage gap changes in 2020 – If you need many medications, or expensive ones, be aware that you might pay more for your medications once you’ve spent a certain amount in one calendar year. If you and your Medicare Prescription Drug Plan exceed the initial coverage limit ($4,020 in 2020), you’ll enter the Medicare Part D coverage gap (donut hole). Although this gap officially closes in 2020, you might still need to pay a different amount after you spend past the initial coverage limit. Read more about your costs in the coverage gap.
- Part D IRMAA – If your income is over a certain amount, you might have to pay more for a Medicare Prescription Drug Plan. Read about the Part D IRMAA adjustment amount. IRMAA stands for Income-Related Monthly Adjustment Amount.
- It’s easy to do your own search for Medicare plan options anytime on your own – you can even enter your medications to see if a plan may cover them.
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
Do I Need to Be Healthy to Qualify for Medicare Coverage?
If you have health issues and you’re new to the Medicare program, you could wonder whether this may affect your Medicare coverage. Learn how Medicare works when it comes to health status.
Medicare coverage of pre-existing conditions
In general, Original Medicare (Part A and Part B) covers any pre-existing conditions you had before you became eligible for Medicare. Some people can even qualify for Medicare coverage because of certain health conditions: disabled individuals and those with end-stage renal disease (ESRD) or Lou Gehrig’s disease may become eligible for Medicare coverage before 65.
So, your health status at the time you enroll shouldn’t affect your Medicare coverage. It’s a good idea to enroll when you’re first eligible for Medicare coverage to avoid late-enrollment penalties, but your Original Medicare coverage and costs shouldn’t otherwise be affected due to your health.
Medicare Advantage and Medicare coverage of end-stage renal disease
Things work differently if you have end-stage renal disease and want Medicare coverage through Medicare Advantage (Part C). While Medicare Part C must cover at least the same level of benefits as Original Medicare, you’re generally not allowed to get Medicare coverage through a Medicare Advantage plan if you have ESRD at the time you apply for enrollment.
There are some exceptions. You may also be able to get Medicare coverage through a Special Needs Plan, a special type of Medicare Advantage plan that limits enrollment to those who live in an institution; have both Medicare and Medicaid coverage; or have certain chronic health conditions, such as cancer or ESRD. If there’s a Chronic-Condition SNP targeting people with ESRD in your service area, you may be able to get Medicare coverage this way.
Medicare Supplement and Medicare coverage of pre-existing conditions
Another time when your health status could affect your Medicare coverage is if you’re purchasing Medicare Supplement (Medigap) insurance. These plans are meant to work alongside your Original Medicare coverage to fill “gaps,” such as copayments, coinsurance, and deductibles.
The best time to enroll is during your Medicare Supplement Open Enrollment Period, the six-month window when you’re 65 or older and have Part B. During this period, you have “guaranteed-issue rights” and can’t be turned down for coverage or charged more because of health issues. Once this period is over, insurance companies can require medical underwriting, charge you higher premiums, or reject you outright because of health status. Please note that you may have to face a waiting period of up to six months before the Medicare Supplement plan covers your pre-existing conditions, even if you enroll during your Medigap Open Enrollment Period.
Would you like help exploring Medicare coverage options that may fit your needs? I’d be happy to go over any questions you have.
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
How Do I Know If I Need a Medicare Supplement Plan?
Medicare Supplement insurance plan is one option you may have to work alongside your Medicare Part A and Part B coverage. But do you need it?
What is a Medicare Supplement plan?
Medicare Supplement plans are sold by private insurance companies. They’re designed to help cover some of Original Medicare’s out-of-pocket costs. You need to be enrolled in both Medicare Part A and Part B to buy a Medicare Supplement (Medigap) plan.
What Medicare Supplement plans may cover
Different Medicare Supplement plans may help pay for Medicare Part A and Part B coinsurance, copayments, and/or deductibles. There are up to 10 standardized Medicare Supplement plans available in 47 states.
For example, each standardized Medicare Supplement plan (with names ranging from Plan A to Plan N) may cover Part A inpatient hospital care (coinsurance and hospital costs) for 365 days after your Medicare benefits have expired. Each of these plans may also cover at least part of your Medicare Part B coinsurance or copayments. Take a look at what each of the standardized Medicare Supplement plans may cover.
Do you need a Medicare Supplement plan?
Only you can decide if you need a Medicare Supplement plan. You might want to take a look at how much you usually spend on health care, including Medicare out-of-pocket costs if you already have Medicare. If you generally have (or expect to have):
- Many doctor visits every year
- Frequent hospitalizations
- Medicare Part B coinsurance or copayments for Medicare-approved durable medical equipment or supplies
…then you might want to add up your out-of-pocket costs – including deductibles – for Part A and Part B and compare them to what you’d pay for a year of Medicare Supplement insurance. Keep in mind:
- Some Medicare Supplement plans may pay Part A and/or Part B deductibles, but others don’t.
- Some Medicare Supplement plans may themselves have deductibles to pay.
There are other things you might want to consider when figuring out if you need a Medicare Supplement plan. For example, Medicare Supplement Plans K and L have maximum out-of-pocket limits. This means that if your Medicare out-of-pocket spending reaches a certain amount, and you’ve paid your Medicare Part B deductible, the plan may cover all your Medicare-covered services for the rest of the year.
This is a lot to think about, isn’t it? If you’d like some help understanding Medicare Supplement insurance and weighing it against other Medicare plan options, I’d be happy to assist you.
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
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Does Medicare Cover Preventive Health Care?
Medicare Part B’s benefits include many preventive health-care services. To name just a few, these may include:
- Flu shots
- Colorectal cancer screenings
- Diabetes screenings
- Pneumococcal (pneumonia) shots
Part B is the medical insurance arm of Original Medicare, which also includes Part A (hospital insurance).
According to the Centers for Medicare & Medicaid Services, preventive health care is important to help avoid illness or manage a health problem before it becomes severe.
“Welcome to Medicare” preventive visit
Medicare begins your preventive health-care benefits when you’re first enrolled in Part B: you get a “Welcome to Medicare” preventive visit. Medicare Part B typically covers this visit once during the first 12 months you’re enrolled. This visit may include certain measurements and screenings, such as:
- Blood pressure
- Height and weight
- Basic vision test
- Certain vaccinations and screenings
- A health-care plan from your doctor that lists the services you need, such as a colorectal cancer screening, mammogram or prostate test, and shots
Preventive health care: wellness visits
After your first year as a beneficiary, Medicare Part B also covers a wellness visit every year. Your doctor will review your health history, current health status, and create a personalized prevention plan that lists the screenings and other preventive health care you need.
Other Part B preventive health-care services
Part B generally also covers the following preventive health-care services when provided by a doctor that accepts Medicare assignment:
- Screening for depression
- Colonoscopy (or other colorectal cancer screening): there are several types of tests, and Part B may cover them at certain intervals depending on the type of test, your age, and your health history.
- Bone density screening for people at risk for osteoporosis and meet certain conditions
- Diabetes screenings for people at risk for diabetes (or diagnosed with pre-diabetes)
- Obesity screening (to tell if you’re overweight) for anyone with a body mass index of 30 or higher
This is not a complete list – Part B generally covers a wide range of preventive health-care services. You might have to make a copayment or coinsurance payment, and the Part B deductible may apply.
Preventive health-care vaccinations
Medicare Part B may cover certain shots to help prevent diseases:
- Flu shot (usually one shot per flu season)
- Pneumococcal (pneumonia) shots
- Hepatitis B shots for those at medium to high risk of the disease
You generally don’t have to pay for these shots, as long as the health-care provider who gives them to you accepts Medicare assignment.
Medicare Part D is optional prescription drug coverage. It’s available either through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. If you have either type of Medicare Prescription Drug Plan, it may cover certain preventive vaccinations, such as
- TDAP booster shot – to prevent tetanus, diphtheria, and pertussis (whooping cough)
- Shingles shot – to prevent shingles, which is a painful skin rash, according to the Centers for Disease Control
Ask your Medicare Prescription Drug Plan for details about coverage.
Do you have questions about Medicare plan options and their coverage of preventive health-care services? You can ask me.
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
Can I Get Vaccines Covered by Medicare?
According to the U.S. Department of Health and Human Services, a vaccine prepares your body to fight a disease by giving you a very small amount of a weak or dead germ that causes the disease. Vaccines are especially important for older adults since your immune system weakens with age. Medicare covers vaccines through Part B (medical insurance) and Part D (prescription drug coverage).
What vaccines do Medicare Part B cover?
Flu vaccines: The influenza virus causes seasonal flu epidemics each year. The flu results in a cough, sore throat, body aches, and other uncomfortable symptoms. Medicare Part B generally covers one flu shot per flu season. You usually pay nothing for this vaccine if your provider accepts Medicare assignment.
Hepatitis B vaccine: The hepatitis B virus causes a serious liver infection according to the Mayo Clinic. Medicare Part B may cover a hepatitis B vaccine if you are at high to medium risk of contracting hepatitis B. You may be at higher risk of contracting hepatitis B if you have end-stage renal disease or diabetes. If you are determined to be at high or medium risk, you generally pay nothing for the hepatitis B vaccine. However if you are at low risk and want the vaccine anyway, you may not be covered.
Pneumococcal vaccine: The pneumococcal vaccine helps prevent certain types of pneumonia. Pneumonia can be a life-threatening condition that fills the air sacs in your lungs with fluid, according to the Mayo Clinic. The pneumococcal vaccine may be given as two shots a year apart and Medicare may cover both. Your doctor will be able to tell you if you need one or both shots. You generally pay nothing for pneumococcal shots if your health provider accepts assignment. Learn more about Medicare coverage of the pneumonia vaccine.
What vaccines do Medicare Part D cover?
Medicare Part D is optional prescription drug coverage through a private insurance company. You can get prescription drug coverage through a stand-alone Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage. Generally Part D covers all commercially available vaccines needed to prevent illness.
Tdap vaccine: Tdap is the adolescent and adult booster shot for tetanus, diphtheria, and pertussis (also called whooping cough). The Tdap vaccine is generally covered under Medicare Part D plans. Learn more about Medicare coverage of the Tdap vaccine.
Shingles vaccine: Shingles is caused by the same virus that causes chicken pox according to the Mayo Clinic. Shingles causes a painful rash that can occur anywhere on the body. The shingles vaccine can reduce the risk of shingles by 51% according to the Centers for Disease Control and Prevention. The shingles vaccine is generally covered by Medicare Part D. Learn more about Medicare coverage of the shingles vaccine.
Do you have more questions about Medicare coverage of vaccines?
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
Can I Enroll in a Medicare Prescription Drug Plan if My Initial Enrollment Period is Over?
If you missed your Medicare Initial Enrollment Period but you want to sign up for a Medicare Prescription Drug Plan, it’s not too late. There are several time periods when you may be able to enroll. Here’s a brief rundown of these opportunities to enroll.
There are two types of Medicare Prescription Drug Plans:
- Stand-alone Medicare Part D Prescription Drug Plan
- Medicare Advantage Prescription Drug plan
The enrollment periods described in this article generally apply to both types of plans.
Medicare Prescription Drug Plans and the Medicare Initial Enrollment Period
Your Medicare Initial Enrollment Period (IEP) is generally a seven-month period surrounding the time when you’re first eligible for Original Medicare, Part A and Part B. It typically includes the three months before the month you turn 65, includes your birthday month, and continues for three more months. If you qualify for Medicare under the age of 65, your IEP can be different.
You can sign up for a Medicare Prescription Drug Plan during your IEP, but what if you don’t?
First of all, Medicare prescription drug coverage (under Medicare Part D) is optional. However, if you don’t sign up when you’re first eligible, you could face a Part D late enrollment penalty if you decide to sign up later.
Secondly, there are other opportunities to enroll in a Medicare Prescription Drug Plan, as described below.
Medicare Prescription Drug Plans and the Fall Open Enrollment Period
Medicare’s Annual Election Period (AEP) is also known as the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, or the Fall Open Enrollment Period.
During this period, which runs from October 15 to December 7 every year, you can make several different changes to your Medicare coverage – including signing up for a Medicare Prescription Drug Plan.
Medicare Prescription Drug Plans and the Medicare Advantage Open Enrollment Period
If you’re enrolled in a Medicare Advantage plan, and you decide to leave the plan and return to Original Medicare (Part A and Part B), you can do this during the annual Medicare Advantage Open Enrollment Period, which runs January 1 –March 31 each year. During this period, you can also sign up for a stand-alone Medicare Part D Prescription Drug Plan if you had Medicare Advantage. You can also switch from one Medicare Advantage plan to another.
Medicare Prescription Drug Plans and Special Enrollment Periods
In some cases, you may be able to sign up for a Medicare Prescription Drug Plan during a Special Enrollment Period. There are several ways you might qualify for such a period; read about them in Can I Delay Medicare Part D Enrollment?
Keep in mind that no matter what Medicare Advantage plan you sign up for, you need to continue paying your Part B premium, along with any premium the plan may have.
It may be a good idea to compare all Medicare Advantage plan costs, not just premium amounts, when you’re shopping for a plan.
To get started, simply click the Get Quotes button to schedule a phone call or to request a personalized email.
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