Click below on our "Frequently Asked Questions" for more information or contact the Council on Aging.
Frequently Asked Questions
All our counselors are well trained in Medicare and will review your options. These options include Medicare parts A & B, Medicare Advantage Plans (Part C), Medicare Prescription Drug Plans (Part D) and Medicare Supplement Plans (Medigaps). We will also review eligibility for Public Assistance programs such as Prescription Advantage, Extra Help from Social Security, MassHealth and other programs to assist beneficiaries with limited resources to pay for health care costs. If you are a Swansea resident and need to speak with a Counselor, please call 508-676-1831.
Part A - Hospital Insurance: Medicare A covers inpatient stays, including semi-private room, food, and tests.
Part B - Medical Insurance: Part B coverage includes outpatient services, testing, doctor visits and doctor services in a hospital. Part B is optional and may be deferred if the beneficiary or his/her spouse is still working and has group health coverage through that employer.
Part D - Drug Coverage: Anyone with Part A or B is eligible for Part D. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all.
Part C - A Combination of Part A, B and D Benefits: These plans are also called Medicare Advantage plans. Part C plans are usually Health Maintenance Organization (HMO's) and Preferred Provider Organization (PPO's). HMO's are networked to provider groups. PPO's allow a beneficiary to go out of the network. For almost all Part C plans, the beneficiary is required to have a primary care physician; that is not a requirement of Original Medicare. Part C Medicare Advantage health plan members typically pay a monthly premium as well as co-pays in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care, annual physicals, coverage outside the United States, and even gym or health club memberships.
CHOOSING A PLAN
With many Medicare Plan Options available, it can be difficult to find the right health plan for your medical needs. Whether you’re looking for a Medicare Advantage Plan or Medicare Part D Plan, our Medicare insurance counselors help you find the right plan to minimize your out of pocket Medicare costs. Please call us for assistance.
Medigaps - also known as Supplemental Plans
- Original Medicare has Part A and B deductibles, and only pays 80% of Part B costs. Medigap plans compliment original Medicare and cover part of or all of what Medicare does not cover.
- Medigaps are not networked so a beneficiary can go to any doctor or hospital that accepts Medicare, nationwide.
- Medigaps DO NOT cover drugs.
- A Medicare Prescription Drug Plan (or Part D Plan) is required in addition to your Medigap.
Talk to one of our counselors about plans, coverage and costs in our area.
Medicare Advantage Plans (Part C)
- Medicare Advantage Plans are a combination of Medicare Part A (Hospital) and Part B (Medical) benefits, additional health insurance and drugs.
- These plans are typically Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). HMO’s are strictly networked, meaning a beneficiary must go to doctors and hospitals contracted
- with the plan.
- PPO’s allow a beneficiary to go outside of the plans network, however the doctor or hospital must agree to accept the insurance.
- Doctors and hospitals are not required to take PPO’s.
- Medicare Advantage Plans usually have monthly premiums, co-pays and deductibles.
- Medicare Advantage Plans are also subject to the coverage gap or “donut hole” with regard to prescriptions.
- These plans may offer “extras” like annual physicals, dental and vision coverage, credit toward glasses, gym memberships, etc. Talk to one of our counselors about plans, coverage and cost in our area.
Medicare Prescription Drug Plan (Part D)
Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare. These are private drug plans that contract with Medicare to provide drug coverage. These plans have premiums, some have deductibles, they have copays, and are subject to a coverage gap/donut hole.
Medicare Advantage Plan (Part C - like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage plans are subject to the donut hole.
All Drug Plans are Subject to the Coverage Gap Know Better as the Donut Hole
The Medicare drug plans have different payment stages. The "donut hole" refers to a partial gap in prescription drug cost coverage under Medicare Part D or Medicare Advantage Plans.
In 2022, once you reach $4,430 in prescription drug costs (which include both your share of covered drugs and the amount paid by your part D plan) you will be in the coverage gap. In 2022, you can expect to pay 25% of the cost of prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $10,690.20, you qualify for "catastrophic coverage." At that point, you are responsible for only 5% of your prescription drug costs for the rest of the year.
If you are computer literate and would like to research the costs of a Medicare Part D plan, you can go do so by visiting the Medicare website at www.medicare.gov. You MUST create a My Medicare Account. Be sure to have your Medicare Card with you when doing so. You will be required to enter the necessary information in order to complete registration for your personalized My Medicare Account and then you will be able to do a personalized drug search. You will be asked to enter the name(s) and dosage of your drugs. Once you have added the drug information, be sure to click "ADD DRUG" to your list. After all medications have been added, you will be asked to select your pharmacy. We strongly suggest you select multiple pharmacies. Drug plans all have different "preferred pharmacies", which dictate different pricing. By selecting ONLY one pharmacy, you are limiting your search results, which may result in higher drug costs. Once your drugs and pharmacies have been determined, you will be ready to compare plans. ALL drug plans available to you will be populated. When comparing plans, be sure to filter your search by selecting plans by "Lowest Drug & Premium Costs". Lists will usually populate with your must current plan first, followed by the comparison plans in the most cost-effective order. Place check boxes in your current plan and then in the next one or two plans following your plan. This will give you a side-by-side comparison of drug costs. Additional details on how to do your own search are available and can be obtained by calling the COA at 508-676-1831.
NEED HELP INTERPRETING YOU PART D SEARCH RESULTS?
It can be difficult to interpret the results from the Medicare Part D Plan Finder tool at the www.medicare.gov website. If you need assistance interpreting or validating the results of your search or if you'd like us to do your drug search for you, we can help. We need your help too! We will require you to fill out a Medicare Part D Drug Search Form, which can be found on our "Important Forms & Documents Page". Just print the form and fill it out completely. Be sure to read the form in its entirety! It contains important information about how to fill out the form. Inaccurate forms with missing information will result in delays in appointment times. Once completed, return it to us and we'll do the rest. The Medicare Part D Drug Search Form is also available at the COA. If you would like to pick one up or have it mailed to your home, please call us at 508-676-1831.
If you are NOT receiving Social Security benefits prior to turning 65, you need to contact the Social Security Administration to sign up for Medicare. You have a seven-month window to do this, beginning three months before your 65th birthday, the month of your birthday, and three months after your 65th birthday. Remember that the later you sign up, the later your Medicare benefits will begin.
Medicare Part A is premium free to most beneficiaries and covers costs associated with a hospitalization. The beneficiary is responsible for a deductible that changes annually and Medicare will pick up the remainder of hospital charges. Medicare Part B has a monthly premium and deductible. Part B typically pays 80% of the cost for your physician and any other outpatient services and the beneficiary is responsible for the remaining 20%. Importantly, if either you or your spouse is gainfully employed and your insurance is provided through that employment, you may defer enrollment in Part B. You should discuss this with Social Security when you initially sign up. You also have options such as Medicare Supplement Plans (MEDIGAP) or Medicare Advantage Plans (Part C) to assist you with costs not covered by Medicare.
Medicare Part D helps beneficiaries with the cost of prescriptions. There are a number of stand alone Drug plans available in Massachusetts. However, if you have a Medicare Advantage Plan (Part C), you need to get your prescriptions through that plan.
The best source for answers to questions about these benefits is to speak with one of our independent Medicare consultants. Swansea residents can call the Swansea COA at (508) 676-1831 for an appointment with one of our counselors.