b'Associate Member Newsare covered under Medicare Part D (see below). Part B requiresWhats the Difference Betweenthe insured to pay a monthly premium (projected to be $185 in 2025), but individuals with higher adjusted gross income or those who dont enroll when they are first eligible (unless they main- Medicare and Medicaid?tained other coverage at the time) may be charged more. Similar to Part A coverage, Medicare Part B has an annual deductible (projected to be $257 in 2025), coinsurance and copayments, but those things are generally covered if you have a Medigap policy.Medicare Advantage(Part C)Medicare Part C is anMedicarealternative to Original Medicare that totally replaces MedicareMedicaidParts A and B (which must still be activated andFederal Program Federal & State in effect). Medicare Advantage plans are run byProgramprivate health insurance companies rather than by the federal government, and they include all benefits and services covered under OriginalMedicare is an insurance programthat is run by the Medicare [and usually coverage for prescrip- federal government. It provides health insurance coverage for the tions drugs (Part D)]. These plans often include a few throw-inpeople who are at least age 65 and for certain disabled individu-benefits and services at no additional cost (e.g., fitness center ac- als who are younger than age 65. In contrast, Medicaid is an cess, dental care, eyeglasses and wellness programs); however, ininsurance program that is run jointly by the federal government exchange for the low premium and additional benefits that oftenand various state governments. Medicaid provides long-term accompany these plans, participants must generally accept moremedical and custodial care coverage to low-income individuals restrictive provider access and limited travel coverage. It is alsoand families.important to note that Medicare Advantage plans often require members to choose a primary care doctor, they usually requireWhat are Medicare Supplementreferrals to see a specialist, they exclude out-of-network cover-age (except for emergencies), and they have very restrictive (and often intrusive) medical management provisions and restrictive(aka Medigap) Insurance Policies?enrollment (and disenrollment) requirements.Medicare Part D(Prescription Drug Coverage)This part ofMedigap policies are health insurance policiesthat Medicare is run by Medicare-approved private insurance com- are sold by a private insurance company to supplement Origi-panies, and it helps cover the cost of outpatientnal Medicare coverage. These Medicare Supplement insurance prescription drugs (including many recom- policies (several of which are offered by WMI) can help pay the mended vaccines). Most Medicare prescriptionenrollees share or fill in the gaps of the costs of Medicare-drug plans charge a nominal monthly premium,covered services (e.g., coinsurance, copayments, or deductibles). and many only pay for certain drugs that are onIn order to be eligible to purchase a Medigap plan, the applicant the plans predetermined list of covered drugs or formulary list.must be enrolled in Medicare Part A and Part B. Insurance com-There are different levels of Medicare Part D coverage (somepanies are prohibited from selling a Medigap plan to an individu-or all of which may apply to your particular plan), and coverageal who is on a Medicare Advantage plan (unless that individual is varies significantly in each level: (1) the annual deductible (any- dropping the Advantage plan).where from $0-$590 in 2025) during which time you pay the fullAlthough the Medigap naming conventions are similar to the cost of certain drugs; (2) the initial coverage stage during whichnames of the various Medicare parts, the standardized Medigap time you pay a basic copayment or coinsurance amount (e.g., $10plans and their alpha names (Plans A-N) are totally different and or 25%); and (3) the catastrophic coverage stage once youveshould not be confused. The most basic Medigap plan (Plan A) spent $2,000 (in 2025) in out-of-pocket costs (which I believe in- covers the Medicare Part A coinsurance and hospital costs (up to cludes the Part D deductible), after which time you will pay noth- an additional 365 days after Medicare benefits are used). It also ing. It is important to note that while Medicare drug coverage iscovers Medicare Part B coinsurance or copayment costs, the first optional, anyone who doesnt sign up for Part D coverage whenthree pints of blood, and the Part A hospice care coinsurance or first eligible is subject to a significant and permanent late enroll- copayment costs. The other Medigap plans all cover these same ment penalty of 1% of the national base premium amount ($36.78benefits that are covered by Plan A (most at 100%), but add vary-in 2025) times the number of late enrollment months. Also, likeing levels of coverage for other things like skilled nursing facility Part B, higher income individuals are subject to a Medicare Partcare coinsurance, Medicare Part A deductible, Medicare Part B D premium surcharge. deductible, excess charges, and foreign travel emergency.Medicare publishes a Medicare Supplement guide called Choosing a Medigap Policy: A Guide to Health Insurance for WPMA News /Winter 202451'