More than 50% of Medicare beneficiaries in Florida are enrolled in Medicare Advantage plans, compared with the national average of 42%, making it the healthcare program of choice for seniors in the state.
In Florida, 51% of all Medicare beneficiaries who are enrolled in Medicare Advantage plans share by county ranges from 16% in Monroe County and a whopping 73% in Miami-Dade County.
This number has more than tripled since 2000, going from 7 million to 26 million in 2021.
The appeal of Medicare Advantage plans has largely to do with the costs and savings from prescription drug coverage. What is the difference between Medicare Advantage plans and Medigap plans? Let’s check it out:
Medigap vs. Medicare Advantage
Both Medicare Advantage and Medigap are supplemental options to your Original Medicare plan. Medicare Advantage plans work similar to an individual or employer HMO or PPO plan, helping lower out-of-pocket costs with predictable copayments, smaller deductibles and out-of-pocket costs. You can also save money with a Medicare Advantage plan by seeing a doctor within the plan’s network.
On the other hand, Medigap plans work with your Original Medicare to help pay for most or all of your out-of-pocket costs that Original Medicare doesn’t cover, like copayments, coinsurance and deductibles. Medigap plans also give you more flexibility when it comes to doctor choice, because you can go to anyone who accepts Medicare.
You’ll have higher monthly premiums but pay less (or nothing) when you receive care. Unlike Medicare Advantage plans, Medigap plans do not include prescription drug coverage—you have to purchase a separate Part D plan.
It’s important to remember that these two plans do not work together. If you have a Medicare Advantage policy, you cannot enroll in a Medigap plan—and vice versa.
Medicare Part D (Prescription Coverage)
PRESCRIPTION DRUG COVERAGE
Part D is your prescription drug coverage, but it can be one of the most confusing and cost prohibit parts of coverage for Medicare. There are four phases of coverage within Part D: Deductible, Initial Coverage Level, Coverage Gap AKA The Donut Hole, and the Catastrophic Phase!
The Initial Coverage Level… The initial coverage level is where 81% of people stay throughout the year. Its based on where drugs fall in the formulary. Tiers 1 & 2 are usually $0 copay in this phase while Tiers 3, 4 and 5 warrant a higher copay.
The Donut Hole!!
19% of Part D beneficiaries find themselves in the Donut hole each year. This is related to a variety of high-priced drugs. When you are in the donut hole brand name medications will cost you 25% of the MSRP cost until you climb out of the donut hole.
At some point, people with exceptionally high-priced medications enter the Catastrophic Phase and their drugs become limited to 5% of the MSRP cost of the drugs themselves.
Part D Costs
According to CMS(Centers for Medicare & Medicaid Services), the average cost for Part D is $33.06 a month. Depending on the plan you choose your costs could be lower or higher. For Part D we use an analysis of your preferred pharmacy and will recommend the plan that covers most of our clients’ medications.
Questions about your current coverage or are you eligible for Medicare and not sure which direction to go? Give us a call! We’re the number one health insurance and Medicare agency in South Florida!