Basic Concepts of Medicare
Laying a Solid Foundation | Lesson 7

Combinations of Medicare Coverage Options

By now, you’ve probably realized there’s no one-size-fits-all option when it comes to Medicare.

And that’s a good thing, because we all have our own unique health needs.

But understanding the individual parts of Medicare and how they can work together or replace each other is how you can learn to recommend the best path for your clients based on those needs.

Now that we’ve broken down each individual part, let’s take a look at some of the combinations that beneficiaries can select for their Medicare coverage.

And just a disclaimer here, we will cover these options and why clients may choose one over the other in far more depth and detail in upcoming modules and lessons.

For now, consider this a high-level, 30,000-foot view, so to speak.

First up, we’ll start with the Original Medicare route.

If a consumer chooses to enroll in Original Medicare, their first decision is whether to pick up both Part A and Part B.

As long as they have one of these parts, they are eligible to add a Part D plan for their prescription drug coverage.

Should the consumer pick up both Part A and Part B, they will have basic Medicare coverage, but they will still have that out-of-pocket exposure we mentioned earlier.

They are also eligible to add a Part D plan.

If a beneficiary has Part A and Part B, but wants to mitigate their out-of-pocket exposure, they can choose to pay the additional premium for a Medicare Supplement plan.

And then of course, they are also eligible to add a Part D plan as well for prescription drug costs.

So that’s what Original Medicare coverage options look like.

Now, let’s take a look at going the Medicare Advantage route.

Instead of getting their coverage through Original Medicare, a consumer may choose to get their coverage from a Medicare Advantage plan in their area.

At this point, the decision comes down to which type of Medicare Advantage plan they would like to go with.

Remember, all Medicare Advantage plans replace the Part A and Part B coverage of Original Medicare. And the vast majority of them include prescription drug coverage, making these plans essentially a one-stop-shop.

There are certain Medicare Advantage plans that are designed to be paired with a Part D prescription drug plan, and there are some that do not include drug coverage at all.

In those rare cases, beneficiaries will either select a Part D plan, or they may get their prescription coverage through another means of creditable coverage, for example VA benefits, or a spouse’s coverage through work.

I do have to mention here though, in these rare cases, you’ll need to verify that the MA plan will allow for a stand-alone PDP ahead of time to avoid potential headaches and late enrollment penalties in the future. And we will cover this in more detail in future lessons.

At this point, we’ve gone through the basics of the parts of Medicare and how they fit together.

We’ve also shown how you, as the agent, are an integral part in helping beneficiaries understand their options and choose their coverage.

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