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Medicare.gov - Tutorial - Your Personalized Medicare Plan Summary

Now we have arrived at the Medicare plan summary page. From this page we can get an overview of the selection of Medicare Advantage plans and Medicare Part D prescription drug plans available in our area - along with Original Medicare.

Medicare.gov - Tutorial - Your Personalized Plan List (Plan Overview)



Medicare.gov - Tutorial - Your Personalized Plan List (Plan Overview)
The left side of the Medicare Plan Finder summary page shows some of the options available for the user. In this area, we can decide to un-check the Medicare plan types that we do not want to consider at this time. In this example, we will un-check Medicare Health Plans without drug coverage and Medicare Health Plans with drug coverage. This means that we will only be looking at Medicare Part D prescription drug plans. We will not change any of the other variables that are adjustable (like Initial Deductible or amount of the monthly premium).

Medicare.gov - Tutorial - Your Personalized Plan List - Other Options You can Choose

Medicare.gov - Tutorial - Your Personalized Plan List (Plan Overview)
Too many Medicare plan choices?
One of the difficult parts about choosing a Medicare plan each year is trying to decide what type of plan you want for the next year. Stand-alone Medicare Part D prescription drug plans (or PDPs) only provide you with prescription drug coverage without any additional health plan coverage (aside what you get from your Original Medicare Part A (In-patient hospital coverage) and Medicare Part B (out-patient doctors office visits)). Medicare Advantage plans without prescription drug coverage provide you only Medicare health benefits and no prescription drug coverage (or MAs). Medicare Advantage plans that also offer prescription drug coverage (or MA-PDs) provide both Medicare health and prescription drug coverage - often at a very low or $0 monthly premium. However, a Medicare Advantage plan can also come in different forms and provide additional service. In short, the analysis of choosing a Medicare Advantage plan is much more complicated than choosing just a Medicare Part D prescription drug plan. To begin this example, we will only examine stand-alone Medicare Part D prescription drug plans that do not include additional Medicare Part A or Medicare Part B coverage.

Medicare.gov - Tutorial - Your Personalized Medicare Plan List Options

All kinds of options to help you narrow your Medicare plan search - which do you need?
All kinds of options to help you narrow your Medicare plan search - which do you need?
We usually do not change many of the options that are available to us, unless we are looking for a very specific type of Medicare plan. If you do decide to change options, make sure you click on "Update Plan Results" or the changes you made will be lost. Let us take a look at some of the options.

  • Select your plan types - as discussed above, this is how you can be sure that you are only seeing the Medicare plans (PDP, MA, MA-PD) that interest you.

  • Limit Your Monthly Premium - you might be able to narrow your search later by reducing the monthly premium, but before you know what coverage is offered by the Medicare plans, the monthly premium amount is not something that you can logically limit. If only one plan in the area covers your expensive medications and the plan has a high monthly premium, the extra hundreds of dollars of premium will be a lot less than the extra thousands of dollars you will spend when paying for your own drug out of pocket. Come back to this later if you want to reduce the number of plans available to you. But again, if you have large prescription needs, monthly premiums will be one of your lowest costs - the key is to look at your total costs across the year - and not just one part of the cost.

  • Limit Your Annual Deductible - again, why limit your deductible when you may also limit plans with better coverage or better overall cost. Some people just do not like an initial deductible, but you may save money over the year with a Medicare plan that has an initial deductible.

  • Change Health Status - one of our favorite Medicare questions. Asking someone about their Health Status really depends on the person or the person's outlook on life. We have spoken with people who are 65 and have the seasonal flu and they say their health is Poor or worse. And we have spoken with people over 90 who consider their health Excellent because they are able to enjoy yet another day of their life. You answer to this "Health Status" question will change the amount of money that Medicare estimates you will spend each year on your personal health care. The question is important for purposes of cost, but this question is also definitely not easily answered either systematically or objectively.

  • Select Coverage Option - here you can select Medicare plans that offer nationwide coverage or allow you to see any doctor (Medicare health plans only). Medicare Part D plans have a national network of pharmacies and by their nature really offer nationwide coverage - maybe there is some plan that is an exception, but we have not found it. Again, you may wish to skip this question if you are only looking for a prescription drug plan. If you are interested in a Medicare Advantage plan that offers Medicare health coverage, then you may be concerned with network restrictions associated with a Medicare Advantage plan. For instance, some Medicare Advantage HMOs have a rather restrictive network and you will pay full price for services if you go outside of the HMO network. But, many HMOs have a network that is vast and have a low monthly premium cost.

  • Select Special Needs Plans - a Special Needs Plan (or SNP) is a type of Medicare Advantage health plan that has prescription coverage and is focused on a certain group of people with a chronic condition (ex: diabetes) or economic limitation. SNPs are not available everywhere and you must meet the financial or physical requirements to join (and stay in) a SNP. If you are only interested in a stand-alone Medicare Part D plan, then a SNP or other Medicare Advantage plan will not be shown in your search results.

  • Select Drug Options - here you can choose to only view Medicare Part D plans that cover your medications or have no usage management restrictions provide gap (Donut Hole) coverage or mail order. Again, you may not see the most affordable Medicare prescription drug coverage if you limit your search too early. If your medication is subject to usage management restrictions (quantity limits, step-therapy, prior authorization), then it is likely that many plans will all have similar restrictions to protect the medication user.

  • Select Plans by Company - if you are only interested in working with one company, then you can choose this option and select you insurance company or Medicare plan provider. Remember, you may never know if your chosen plan is the most affordable if you limit your search only by plan.

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.