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What Additional Medicare Coverage Is Available?

Understanding what’s included and excluded from each Medicare plan can help you decide on the right option.

HealthPlans of NC

Health Plans of NC, Kelly Quinn

Medicare offers several plans besides Original Medicare Part A (hospital) and Medicare Part B (medical). Each plan offers various benefits and can provide additional coverage to meet your needs and budget. If you’re based in North Carolina, our experienced Medicare Advantage agents Charlotte can talk you through all the options, which include:

  1. Medicare Prescription Drug Plans (known as Medicare Part D Plans)

  2. Medicare Supplement Insurance Plans

  3. Medicare Advantage Plans

  4. Special Needs Plans

Medicare Prescription Drug Plans

Prescription Drug Plans, known as Medicare Part D, operate as stand-alone plans. They help pay for the cost of prescription drugs for anyone in the US, including residents of North Carolina.

You can use a the Medicare Part D Plan independently, with Original Medicare, or with a Medicare Supplement Insurance Plan. This plan offers you lots of flexibility to help reduce prescription medication costs. 

What’s Included in Medicare Part D Prescription Drug Plans?

Medicare Part D Plans help cover the costs of medications. However, as with most insurance plans, there are some requirements and restrictions you need to be aware of. For example, you must reside in the Part D Plan service area to qualify. In addition, certain plans allow you only to use a specific network of pharmacies. 

For prescription drug coverage, there are in-network and out-of-network pharmacies. Drugs are separated into different cost levels and tiers, and the cost of the drug may vary depending on the provider and your plan. Whether the pharmacy is in-network or out-of-network can also affect the cost of the medicine.

What Drugs Are Covered Under the Medicare Part D Plan?

Drugs that are most commonly prescribed for Medicare patients, as determined by Federal standards, are covered under the plan. Your plan will have a formulary that lists all the drugs it covers, which is an excellent place to check. Specific brand-name drugs and generic drugs that appear on the formulary are covered.

Commercially available vaccines not covered under Medicare Part B may also be covered under Medicare Part D.

What Drugs Are Not Covered Under the Medicare Part D Plan?

Knowing what’s not covered can be as important as understanding what is covered. The following drugs are NOT covered in the Medicare Part D Plan:

  • Any drug not listed in the plan’s formulary

  • Prescription vitamins and minerals

  • Fertility or erectile dysfunction drugs

  • Drugs prescribed for cosmetic purposes

  • Hair growth drugs

  • Over-the-counter medications

  • Anorexia, weight loss, or weight gain prescription drugs

  • Any drugs that are already covered under Medicare Part A or Medicare Part B

Medicare Supplement Insurance Plans (Medigap Plans)

Medicare Supplement Insurance Plans help pay for out-of-pocket costs not covered by Original Medicare. Organizing additional coverage for out-of-pocket expenses can help you budget and manage your future medical expenses.

There are various Medicare Supplement Insurance Plans to choose from. The federal government-standardized plans, such as Medigap Plan G, are identified by a letter.

Some features of Medicare Supplement Insurance Plans include:

  • Cover out-of-pocket costs: for those not covered by Original Medicare Part A or Part B.

  • No network restrictions: you can see any doctor who accepts Medicare patients.

  • Portability: if you move outside North Carolina, you can keep your plan.

  • Predictability: your costs are predictable, so there are no surprises in out-of-pocket expenses.

  • Plenty of options: with so many plans to choose from, there’s one to meet most health needs and budgets.

  • Complete coverage: purchasing a Medigap Plan and a Medicare Part D Prescription Drug Plan can offer you comprehensive coverage.

  • Guaranteed for life: they guarantee the plan for life, which means it can’t be canceled, leaving you stranded without coverage. 

Medicare Advantage Plans

Medicare Advantage Part C Plans combine Medicare Part A, hospital coverage, and Medicare Part B, medical insurance coverage, into a single plan with an annual medical out-of-pocket maximum limit. Prescription drug coverage is also often included in the package. In addition, a range of benefits can also be included, such as vision, dental, and fitness.

Included in All Medicare Advantage Plans:

  • Everything is included in Medicare Part A (hospice care is paid for by Original Medicare Part A)

  • Everything included in Medicare Part B

  • Prescription drug coverage

Included in Most Medicare Advantage Plans:

  • Prescription drug coverage

Some Medicare Advantage Plans Offer Additional Benefits:

  • Eye exams, eyeglasses, and corrective lenses

  • Dental cleanings, exams, and X-rays

  • Hearing tests and hearing aids

  • Transportation to medical visits, virtual care provider visits, and other related benefits

  • Fitness memberships and wellness programs

Special Needs Plans

Special Needs Plans offer the same healthcare coverage and services that all Medicare Advantage Plans include, with Medicare Part A and Medicare Part B included. In addition, all provide prescription drug coverage and may offer other services designed for specific groups of people. If you’re considering this option, look at the options to determine which plan you qualify for.

There are four types of Special Needs Plans, each with different benefits and services included:

  1. Dual Special Needs Plans (D-SNPs) are for people who are dual-eligible for both Medicare and Medicaid.

  2. Chronic Special Needs Plans (C-SNPs): for people with severe or disabling conditions.

  3. Institutional Special Needs Plans (I-SNPs): for people in a skilled nursing facility.

  4. Institution-Equivalent Special Needs Plans (IE-SNPs): for people living in a contracted assisted living facility that require the same level of care as those living in a skilled nursing facility.

What Is the Dual Special Needs Plan (D-SNP)

The Dual Special Needs Plan is a Medicare Advantage Plan that combines both Medicare Part A and Medicare Part B benefits and Medicare Part D prescription drug coverage. Dual Special Needs Plans are specifically for people with both Medicare and Medicaid.

Extra support is available to help you coordinate the plan with your Medicaid plan. In addition, additional benefits are provided that aren’t included in either Medicare or Medicaid to offer you greater coverage. Our local Medicare agents in Charlotte, NC, can help if you need information or assistance with D-SNPs.

Extra support is available to help you coordinate the plan with your Medicaid plan. In addition, additional benefits are provided that aren’t included in either Medicare or Medicaid to offer you greater coverage. Our local Medicare agents in Charlotte, NC, can help if you need information or assistance with D-SNPs.

How to Qualify for A Dual Special Needs Plan (D-SNP)

Medicare Parts A and B and full Medicaid benefits are required to qualify for a Dual Special Needs Plan. If you’re eligible for this plan, you’ll receive a letter from the Medicaid office in your state. You also have the option to call the Medicaid office to inquire. You are designated as either “Full Dual-Eligible” or “Partial Dual-Eligible,” depending on your Medicaid benefits.

What Are Some Benefits Included with A Dual Special Needs Plan?

Benefits may include dental, vision, and hearing coverage. You may also be eligible to coordinate care through a personal care coordinator and a Personal Emergency Response System (PERS). Telehealth options include credits, which can buy health products, virtual visits with your care provider, transportation assistance, and other benefits.

Dual Special Needs Plans vary by region and location, so it’s essential to discover what’s relevant to North Carolina. Our team of health insurance agents in NC can help answer any questions you have. 

What Happens to My Medicaid Benefits?

Your eligibility for Medicaid doesn’t change if you take out additional coverage. So your benefits and plan won’t be affected.

What’s Next?

If you want to learn more about Medicare supplements in NC, our team of knowledgeable and experienced Medicare agents can help. We’ll answer any questions about your options, including information about the Medicare Part D open enrollment period, and help assess what plans you qualify for.

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