Medigap - Medicare Supplement

• Helps fill "gaps" in Original Medicare.

• Helps pay some of the remaining health care costs and supplies not covered that Original Medicare:CopaymentsCoinsuranceDeductibles

Medicare will pay its share of the Medicare-approved amount for covered health care costs, then, your Medigap pays its share.

What you need to know about Medigap plans

1. You must be enrolled in Medicare Part A & B.

2. Medigap is NOT a Medicare Advantage. You CAN’T enroll in both.

3. You pay a separate monthly premium for a Medigap plan.

4. Guaranteed renewable is a feature of Medigap.

5. Medigap policies do not include prescription drug coverage. You need to enroll into a separate Medicare Prescription Drug plan (Part D)

6. It is illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage plan unless you are switching back to Original Medicare.

7. Medigap policies do not cover long-term care, vision, or dental care, hearing aids, eyeglasses, or private-duty nursing.

Medicare Part D

• Covers a wide range of prescription drugs

• Has a list of covered drugs (formulary).

• Places drugs into “tiers” have a different cost per tier. For example, a drug in a lower tier will cost you less than a drug in a higher tier.

Formulary Exception Rules

Medicare drug plans may have these coverage rules

• Opioid pain medication safety checks

• Prior Authorization

• Quantity limits

• Step therapy

• Part D vaccine coverage

• Drugs you get in hospital outpatient settings

Formulary Exception requests are common among Medicare Beneficiaries. The request is best handled by your prescribing doctor.

Your doctor feels you need a higher Tier drug instead of a similar lower Tier drug, your doctor may ask your plan for a Formulary Exception or Tier reduction to lower your co-pay may also come into play.