Generally, Medicare is available for people age 65 or older and younger people with disabilities or End Stage Renal Disease. Medicare has Two parts. Hospital coverage is called Part A and is free for most people. Medical coverage is called Part B and has a premium depending on your income. Medicare has very specific and sometimes punitive rules about when you can enroll so its is important for eligible beneficiaries to enroll at the correct time. Part A & B are provided by the federal government and offer a fair amount of coverage. However, there are large gaps in coverage and most prescription drugs are not covered. That's is where a good agent comes in. Medicare beneficiaries need to fill the gaps with either a Medicare Advantage plan (known as Part C) or a Medicare Supplement AND a Prescription Drug plan (known as Part D)
Medicare Supplements "fill in" the gaps of Medicare Parts A&B but do not provide prescription drug coverage. Supplement benefits are standardized and set by the Federal government but sold by private insurance companies. To make matters even more confusing. Supplement are named by letters. The supplements available vary by geography and carrier. For example, in Suffolk county NY there are 12 different supplements available: Plans A,B,C,D,F,F High Deductible, G,G High Deductible K, L,M and N but not all carriers offer all plans. Depending on which plan a beneficiary enrolls in will determine how much of the gaps are covered. Also, as of 1/1/2020 plans C,F and F High Deductible are only available to Medicare beneficiaries who were Medicare eligible before 1/1/20. Plan F is the most popular as it covers 100% of a beneficiaries cost sharing and people like that! one very important point about Medicare supplements is that they allow enrolled members to use ANY provider or facility in the US that accepts Medicare. When one enrolls in a Medicare Supplement they still have most of their claims paid by Parts A&B.
Medicare Advantage Plans also "fill in" the gaps of Parts A&B and usually also include prescription drug coverage. These are the plans many see advertised for $0 plan premiums. Advantage plans require their members to use the carrier network and have deductibles, copayments and coinsurance much like plans they probably had while working. Some Advantage plans use fairly limited networks and some are extensive. It is important for beneficiaries considering an Advantage plan to make certain they are happy with the provider network and cost sharing. Some Advantage plan also offer out of network coverage.
PDP plans can only be sold to beneficaries with an eligible MAP (PFFS, Cost, MSA) plan or Medicare Supplement. PDP plan benefits typically have a deductible, Initial coverage phase, Gap or donut hole phase and the catastrophic phase. Each PDP plan has thier own drug formulary, so it is very important to make sure the beneficiaries drugs are covered by the plan they select.
Selling & helping beneficiaries with Medicare, Supplements, Advantage and PDP plans can be very confusing and that is why it is important to work with an experienced agency that understands how the system works, when people can enroll, what plans are a good match and the pitfalls of working in this market. However, with the aging of the US population we can make you a very successful Medicare agent and help you build a lifetime residual income stream.
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