What You Need to Know About Your Medicare Coverage

By RetireMEDiQ

One of the most common feelings that retirees have about Medicare is that understanding coverage can be complicated. It’s true–there are a lot of plan options available to you, and finding the one that will work best for you is very important. Once you find the right coverage, the next step is to ensure you understand the details of your coverage so you can plan accordingly in terms of the hospitals and doctors that are covered, the costs you will incur, and the prescription drugs that are covered by your plan. It’s likely that all of these items factored into your plan selection, but it never hurts to review the exact plan details once you’re enrolled–and refresh your knowledge of what’s covered year after year. 

Medicare Advantage with Prescription Drug (MAPD) Plans

MAPDs are popular among retirees because they have the “all-in-one” feature that combines traditional Medicare coverage and extra benefits, like vision and dental coverage, as well as prescription drug coverage in a single plan. MAPDs are offered by private insurance companies approved by Medicare. If you’re still determining which type of plan is right for you, you can learn more about Medicare Advantage plans here

Although all MAPDs offer similar types of coverage, the details of specific coverage as well as the portion of costs you will be responsible to pay vary by plan. To fully understand the coverage offered by your plan and your costs, you’ll want to spend some time navigating the following documents. All of these plan-related documents are available to you on your insurance company’s website:

  • Evidence of Coverage: Outlines details such as what the plan covers and what you pay.
  • Formulary: Lists the generic and brand-name prescription drugs covered on the plan. 
  • Summary of Benefits: Contains information about the plan’s benefits and coverage.
  • Annual Notice of Change: Details any changes to the plan’s service area, coverage or costs for the upcoming plan year.

Medicare Supplement Plans

Medicare Supplement plans, also known as Medigap, are health insurance policies sold by private insurance companies. Medicare Supplement plans are intended to be purchased in addition to Medicare Parts A and B, and the Medigap plan fills in the gaps–hence the term Medigap–that Medicare does not cover. Supplement plans protect you from high medical expenses and you rarely receive bills, making your health care budget more predictable throughout the year. On the flip side, you will likely pay a higher monthly premium for a Supplement plan than you would an MAPD plan.  

Because Medigap plans are supplemental to Original Medicare (Parts A and B), you’ll need to understand what Medicare covers. Here are a few places to get started:

  • Medicare.gov’s “What’s Covered?” app or website page allows you to research if a medical test or service is covered by Medicare and how much it will likely cost.
  • Medicare covers a variety of preventive services, including disease screenings, your annual wellness visit and more. Read here for more information.
  • For your prescription drug coverage, you can reference the formulary available on your insurer’s website. It lists the generic and brand-name prescription drugs covered on your plan. 

Prescription Drug Plans

Prescription Drug Plans are sold by private insurance companies and are available to everyone who has signed up for a Medicare Part A and/or Part B plan, or they can be purchased in addition to a Medigap plan. PDPs are much more specific in their coverage, and there’s only one very important document that you’ll need to reference to understand what’s included in your PDP. 

Each PDP will have a formulary available. The formulary lists the generic and brand-name prescription drugs covered on your plan. It’s important to make sure that any prescription drugs you need are covered by your plan’s formulary–otherwise, the cost may be significantly more expensive.

Still Need Help Understanding Your Coverage?

We’re here for you! Contact RetireMEDiQ to speak with a trusted advisor if you have questions about your coverage. We are happy to walk you through the details of your plan

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