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Dissecting Medicare

A closer look at the various Medicare plans
Oklahoman Published: October 11, 2011
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/articleid/3612283/1/pictures/1533562">Photo - Larry Hatley, 65, of Muskogee reviews Medicare drug and health plan information during a senior summit the state insurance department hosted on Monday in Tulsa. PHOTO PROVIDED <strong></strong>
Larry Hatley, 65, of Muskogee reviews Medicare drug and health plan information during a senior summit the state insurance department hosted on Monday in Tulsa. PHOTO PROVIDED

Medicare Part D: Covers prescription drugs through private insurance companies and costs $15.10 a month and up. Beneficiaries are responsible for up to a current annual deductible of $310 ($320 next year); 25 percent of their drug costs up to $2,830 and 100 percent of their costs between $2,830 and $4,550. Within that gap or “doughnut hole,” beneficiaries receive a 50 percent discount on brand name drugs and 7 percent discount on generic drugs (14 percent next year). If you don't sign up for Part D when you become eligible, you may pay a 12 percent annual penalty for life.

Medicare Advantage (also known as Medicare Part C and may include Part D): Beneficiaries who live in metropolitan areas often can lower their out-of-pocket costs by choosing, instead of supplemental insurance, a Medicare Advantage plan. These include HMOs (health maintenance organizations), PPOs (preferred provider organizations), and private fee-for-service plans facilitated by private health insurance companies and may include some additional benefits, such as vision or dental coverage, as well as prescription drug coverage. Thanks to health reform, Medicare Advantage plans beginning Dec. 8 will be rated — based on government oversight and consumer and provider satisfaction — a low of 1 star to a high of 5 stars, and beneficiaries may enroll in or switch to a 5-star plan at any time, even outside of Medicare's annual enrollment period.

Beneficiaries enrolled in Medicare Advantage plans can choose to withdraw from their annual plan and return to traditional Medicare, and pick up a Part D drug plan, during the annual disenrollment period, Jan. 1 through Feb. 14.

SOURCE: Oklahoma Insurance Department


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