Reaching the age of 65 and becoming eligible for Medicare can be a daunting process, with numerous questions about Medicare plans, costs, coverage, and more. This article explains how to prepare for Medicare and outlines some of the basics of how Medicare works.


Medicare comprises four parts:

Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Medicare Prescription Drug Plan). While the federal government administers Parts A and B, private insurance companies handle Medicare Advantage and stand-alone Part D plans.

Medicare Part A typically has no premium, but some exceptions may apply. Part B has a standard premium, with higher premiums for individuals with higher incomes. The costs of Medicare Advantage and Part D plans vary by location and provider, with some areas offering $0 premium plans. It's crucial to continue paying the Part B premium to maintain eligibility for private insurance plans.

Medicare Part D plans are optional but may incur penalties for late enrollment. These penalties can be affected by income, referred to as the Income Related Monthly Adjustment Amount (IRMAA).

Original Medicare (Parts A and B) involves additional costs such as deductibles, copayments, coinsurance, and non-covered services. Original Medicare lacks a maximum out-of-pocket limit, but Medicare Supplement (Medigap) plans can help cover these costs. Note that you can choose either a Medigap plan or a Medicare Advantage plan, but not both.

Veterans may mistakenly believe that the VA healthcare system provides credible coverage, but only the VA pharmacy is considered credible coverage.

When planning for Medicare, consider your specific needs, such as daily prescription drug usage or chronic conditions. Options like Medicare Advantage Prescription Drug plans or stand-alone Part D plans may be suitable based on your requirements. Special Needs Plans are available for those with specific conditions or preferences for comprehensive care.

Medicare Advantage plans offer the convenience of bundled coverage, and the Reliant Insurance Medicare Team can help you find the right plan at no cost. Whether you seek assistance or choose to enroll independently, there is no associated enrollment fee.

Preparing for Medicare involves understanding the various parts and costs associated with the program. Educating yourself to avoid penalties and choosing the right plan to meet your healthcare needs is essential. We are here to help.


Medicare Advantage, key points:

Medicare Advantage (MA) Overview: Medicare Advantage is offered by private insurance companies and provides an alternative way to receive Medicare coverage. It often combines health insurance and prescription drug benefits into a single plan known as Medicare Advantage Prescription Drug (MAPD).

Coverage Comparison: MA and MAPD plans cover everything that Original Medicare (Part A and Part B) covers, except for hospice care, which remains covered by Original Medicare Part A. When prescription drug coverage is included, it is referred to as Medicare Advantage Prescription Drug plans.

Types of MAPD Plans: There are several types of MAPD plans, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Medicare Savings Account (MSA), Private Fee-For-Service (PFFS), and Special Needs Plans (SNP). Each has different rules regarding care access.

Considerations for Prescription Drug Plans: The text emphasizes that if you need prescription drug coverage, you should consider enrolling in a MAPD plan offered in your area. Enrolling in a stand-alone Medicare Prescription Drug Plan (Part D) can lead to disenrollment from your current Medicare Advantage Drug Plan.

Special Needs Plans (SNP): SNPs are designed for beneficiaries who meet specific criteria, such as having a chronic condition, being dual-eligible (Medicare and Medicaid), or residing in an institution like a nursing home. These plans typically include prescription drug coverage tailored to the specific health needs of SNP members.

Formularies and Cost-Sharing: MAPD plans usually list covered prescription medications. Cost-sharing depends on the prescription tier, with generic drugs often having lower costs compared to brand-name drugs.

Costs: The cost of MAPD plans can vary as private insurance companies provide them. Beneficiaries are responsible for monthly premiums, Part B premiums, and any copays, coinsurance, or deductibles associated with the plan.

Enrollment: Eligibility for Medicare Advantage Plans typically requires having Medicare Part A and Part B, residing within a service area, and not having End-Stage Renal Disease (ESRD). Enrollment can occur during various periods, including the Initial Election Period, Annual Enrollment Period, Open Enrollment Period, and Special Enrollment Periods.

Annual Review: We recommend reviewing plan options annually due to potential changes in coverage details and costs.


Medicare Part D, the prescription drug coverage for Medicare beneficiaries key points:

Origins and Eligibility: Medicare Part D was established through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. To be eligible for Part D, individuals must have both Medicare Part A and Part B and live within the service area of the chosen Prescription Drug Plan.

Coverage Options: Part D coverage can be obtained through Stand-Alone Medicare Part D prescription drug plans or Medicare Advantage Prescription Drug plans. Some Medicare Advantage Plans may not cover prescription drugs, such as Individual Cost Plans, Private fee-for-service plans (PFFS), and Medical Saving Account (MSA) plans, allowing beneficiaries to add a stand-alone Prescription Drug Plan if needed.

Medicare Advantage Prescription Drug Plans: These plans combine the coverage of Original Medicare (Part A and Part B) with prescription drug coverage (Part D), excluding hospice care. Different types of Medicare Advantage plans include HMO, PPO, and Special Needs Plans, some of which include prescription drug coverage.

Formularies and Coverage Details: Each Prescription Drug Plan or Medicare Advantage Prescription Drug plan has a formulary listing covered drugs, categorized into Tiers with varying copayment or coinsurance costs. Some drugs, like immunosuppressants and antiretrovirals, are protected and must be included in all plans. The formulary and associated costs can change, and beneficiaries are notified of such changes.

Plan Considerations: Beneficiaries are encouraged to consult licensed insurance agents, such as the Reliant Insurance Medicare Team, to evaluate available Prescription Drug Plans based on individual needs, current health situation, convenience, and preferences. There is no one-size-fits-all plan, making personalized consultation essential for making the right choice.