b'Associate News Wordw w w. w m i m u t u a l . c o mWhat are the Various additional benefits that often accompany these plans, partici-pants must generally accept more restrictive provider access and limited travel coverage. It is also important to note that Medicare Components of Medicare? Advantage plans often require members to choose a primary care doctor, they usually require referrals to see a specialist, they When working with Medicare,I suggest you pay specialexclude out-of-network coverage (except for emergencies), and attention to the distinction between the words part and planthey have very intrusive medical management provisions and which sound alike but are quite distinct in the Medicare context.restrictive enrollment (and disenrollment) requirements.As explained below in greater detail, the word part is generallyMedicare Part D(Prescription Drug Coverage) used to distinguish between the four major Medicare compo-This part of Medicare is run by Medicare-nents (Parts A, B, C and D), while the word plan refers to theapproved private insurance companies, and it different types of Medigap insurance policies that supplementhelps cover the cost of outpatient prescription Medicare coverage (Plans A-N). drugs (including many recommended vaccines). Medicare Part A(Hospital Insurance)Most Medicare prescription drug plans charge This part of Medicare helps cover inpatienta nominal monthly premium, and many only pay for certain hospital care, skilled nursing facilities, hospicedrugs that are on the plans predetermined list of covered drugs and home health care. When Medicare Part A isor formulary list. There are different levels of Medicare Part paired with Medicare Part B, the combined coverage is known asD coverage (some or all of which may apply to your particular Original Medicare. This is in contrast to Medicare Advantageplan), and coverage varies significantly in each level: (1) the (Part C) plans that are health insurance plans that are offered byannual deductible during which time you pay the full cost of private insurance companies in place of Original Medicare (seecertain drug (anywhere from $0-$505 in 2023); (2) the initial below). Those who are insured under Medicare Part A usuallycoverage stage during which you pay a basic copayment or arent required to pay a monthly premium for that coverage,coinsurance amount (e.g., $10 or 25%); (3) the coverage gap or but they are responsible to pay a deductible ($1,600 in 2023) ordonut hole once you and your plan have spent a combined to-copayments and coinsurance for covered services; however, atal of $4,660 (in 2023) on covered drugs during which time you Medicare Supplement policy can be purchased to cover many ofpay a higher percentage of the cost of the drugs (up to 25% for those out-of-pocket costs (see below). brand-name drugs); and (4) the catastrophic coverage stage once youve spent $7,400 out-of-pocket (in 2023) during which time Medicare Part B(Doctor and other Medicalyou usually pay a low copayment or a small coinsurance amount Insurance)This part of Medicare helps cover ser- (e.g. 5%) for prescription drugs. It is important to note that while vices from doctors and other health care providers,Medicare drug coverage is optional, anyone who doesnt sign up hospital outpatient care, durable medical equip- for Part D coverage when first eligible is subject to a significant ment, and home health care. It also covers manyand permanent late enrollment penalty of 1% of the national preventive services, screenings and immunizations.base premium amount ($32.74 in 2023) times the number of late It does not, however, include coverage for prescription drugsenrollment months. Also, like Part B, higher income individuals which are covered under Medicare Part D (see below). Part Bare subject to a Medicare Part D premium surcharge.requires the insured to pay a premium of $164.90 (in 2023), but individuals with higher adjusted gross income or those whoWhats the Difference Between dont enroll when they are first eligible (unless they maintain other coverage) may be charged more. Similar to Part A cover- Medicare and Medicaid?age, Medicare Part B has an annual deductible ($226 in 2023), coinsurance and copayments that are generally covered if you have a Medigap policy. Medicare is Medicare Advantage(Part C)Medicare Partan insurance C is an alternative to Original Medicare that totallyprogramthat is replaces Medicare Parts A and B (which must stillrun by the federal be activated and in effect). Medicare Advantagegovernment. ItMedicareplans are run by private health insurance compa- provides healthMedicaidnies rather than by the federal government, and they include allinsurance cover- Federal Programbenefits and services covered under Original Medicare (and usu- age for the peopleFederal & State ally coverage for prescriptions drugs (Part D)). These plans oftenwho are at leastPrograminclude a few throw-in benefits and services at no additionalage 65 and for cost (e.g., fitness center access, dental care, eyeglasses and well- certain disabled individuals who are younger than age 65. In ness programs); however, in exchange for the low premium andcontrast, Medicaid is an insurance program that is run jointly by 56 www.wpma.com / Fall 2023'