Thinking of Medicare Part D and Medicare Part C (Sometimes Called Medicare Advantage) separately from Medicare Part A and Medicare Part B, you’ll accomplish three things.
First, you’ll understand how Medicare Part D prescription drug plans work with Medicare Part A, and Medicare Part B.
Second, you’ll understand how a Medicare Advantage plan combines all three components, Part A, Part B, and Part D, into a single package, called Medicare Part C, through a local HMO or PPO servicing your area.
Finally, you’ll understand the key concepts to enrollment periods.
Let’s get at it.
Medicare Part D and Medicare Advantage (Part C) Do These Two Things:
- Medicare Part D gives you prescription drug coverage in addition to your Medicare Part A and Medicare Part B, sometimes called “Original Medicare”
- Medicare Advantage generally gives you Medicare Part D in a local HMO or PPO when that local HMO or PPO bundles Medicare Part A, Part B, and Part D (Not all Advantage plans include Part D) into a comprehensive health care package (Medicare Part C) using their network. You must have both Medicare Part A and Medicare Part B to choose a Medicare Advantage Plan, and you will also be subject to the usage rules of the HMO or PPO network you choose
Medicare Part D: Prescription Drugs
There Are Two Ways You Get Medicare Part D:
- Choosing a prescription Medicare Part D drug plan to work with original Medicare
- Choosing a Medicare Advantage Plan that includes its own Part D prescription drug plan
Are These Two Ways Of Getting Medicare Prescription Drug Coverage The Same?
No. They are different in basically two ways: whether you choose original Medicare or you choose Medicare Advantage.
What If I Choose Original Medicare Part D Coverage?
If you are choosing to use original Medicare, you get Medicare Part D prescription drug coverage exclusively by choosing a private Medicare Part D insurance plan.
What If I Choose Medicare Advantage Part D Coverage?
If you are choosing to use a Medicare Advantage plan you must, and will exclusively get prescription drug coverage through the Medicare Advantage plan you choose.
Also, be aware that not all Medicare Advantage Plans carry prescription drug coverage, and if the Medicare Advantage plan you choose is one of those without prescription drug coverage, you can not choose a prescription drug plan from a private Medicare Part D insurance provider.
What Does It Mean If I Choose A Medicare Advantage Plan With No Prescription Drug Coverage?
You will pay for all your prescription drugs.
What Does It Mean If I Choose Original Medicare And A Private Part D prescription Drug Insurance Plan?
It is similar to the way a Medigap Insurance plan works with your original Medicare.
Just like you pay all costs not covered by original Medicare if you do not have a Medigap insurance plan, you pay all your prescription drug cost if you do not have a private Medicare Part D prescription drug plan.
Just like you shop for a Medigap insurance plan from a collection of private Medigap insurance companies, you shop for a Medicare Part D prescription plan from a collection of private Medicare Part D insurance companies.
But, unlike Medigap insurance plans having to be the exactly the same plan to plan coverage from company to company, Medicare prescription drug plans do not have to give you the same company to company, plan to plan coverage.
This means if you buy a Medicare Part D prescription drug plan from Joe’s Medicare Part D prescription drug insurance company, it may not be the same as a Medicare Part D prescription drug plan you could buy from Jane’s Medicare Part D prescription drug insurance company.
Medicare Advantage: Also Known As Medicare Part C
What Is Medicare Advantage?
Medicare Advantage is simply this: A different way to deliver you Medicare Health Services.
How Does Medicare Advantage Fit Into Original Medicare?
In order for you to get a Medicare Advantage plan, you must have both Medicare Part A and Medicare Part B. You will still pay your Part B monthly premium, but you will pay any co-insurance, co-pays, and out of network services you receive as part of using the Medicare Advantage plan you choose.
Medicare Choices: When Can They Be Made
There Two Important Medicare Time Frames To Consider
- Your initial enrollment period
- Other enrollment periods
When Do I Sign Up for Medicare?
You will automatically be enrolled in both Medicare Part A and Medicare Part B if:
- You are already getting social security benefits
- You are getting benefits from the Railroad Retirement Board
- You are under 65 and have been on disability for 24 months
- You have ALS (Lou Gehrig’s disease) and it is the month your Social Security Disability begins
You will have to enroll in Medicare Part A and/or Medicare Part B if:
- You are close to 65 but not getting Social Security or Railroad Retirement Board benefits
- You have End-Stage Renal Disease and you want medicare
How Do I Enroll If I’m Not Automatically Enrolled?
If you are not automatically enrolled in Medicare Part A, you sign up once your initial enrollment period begins.
If you have not worked 40 quarters, or ten years, which means you have to pay the Medicare Part A monthly premium, or you are enrolling in only Medicare Part B, you can enroll
- during your initial enrollment period
- during a special enrollment period
- during the general enrollment period