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  • labje1
    I am almost old enough to start medicare! With MS I am not sure which supplemental plan is best.  What about special needs plans? Suggestions or thoughts PLEASE!
  • MS_Navigators
    Hello labje1,

    I am including some general information about your Medicare options below, but if you would like additional assistance please give us a call at 1.800.344.4867 (M-F 7am-5pm).

    There are different ways to get Medicare Health Benefits – Original Medicare (Parts A & B), Original Medicare with a supplemental insurance, and a Medicare Advantage Plan (Part C).  The following links offer more information about these options:
    • [url=https://www.medicareinteractive.org/get-answers/overview-of-medicare-health-coverage-options/overview-of-medicare-coverage-options/your-medicare-coverage-options?]Medicare Coverage Options[/url]
    • Enrollment Tools
     
    The benefit to enrolling in Original Medicare with a Medigap policy is that these supplemental plans have the potential to really help make Medicare plans affordable by filling in most or all of the gaps in Original Medicare coverage.  The drawbacks are that they often cost several hundred dollars each month, may have pre-existing condition exclusion periods (the Affordable Care Act didn’t change this for Medigaps), and in many states there are only limited times when a beneficiary with MS can purchase a Medigap policy.  Contact your state’s Department of Insurance for more information about your Medigap options. A table that summarizes the benefits under each type of Medigap Plan is available at this link..  You can also learn more about the benefits in the Medicare publication Choosing a Medigap Policy.

    It is important to also purchase prescription coverage, usually by getting a Part D plan. [url=https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/part-d-coverage-overview/medicare-prescription-drug-benefit-part-d?]Here is a link to information about Part D coverage.[/url] You can read about Part D costs [url=https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/part-d-cost-overview/medicare-drug-benefit-part-d-costs?]at this link.[/url]

    Medicare Advantage Plans cover everything that Original Medicare (A & B) covers, but the cost structure is different.  Instead of paying 20% for an MRI or appointment with a specialist, for example, there is often a predictable copay for these services.  Another benefit of Medicare Advantage Plans is that they have out of pocket limits for medical services - no more than around $6700, sometimes as low as $3400 – ensuring that even those with high medical costs will have a limit to what they must pay out of pocket for medical services.  If you’re considering a Medicare Advantage Plan, you should check with your healthcare providers to find out what plans they accept, since most Medicare Advantage plans offer limited coverage outside of networks.  Here are a few other things to consider:
    • Out of Pocket Spending Limits
    • Medication costs
    • Physician/hospital networks
    • Outpatient Care Costs
    • Hospitalization costs
    • Durable Medical Equipment costs

    Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that generally limits membership to people with specific diseases or conditions.  Medicare SNPs tailor their benefits, choose their providers, and create their drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve. 

    Medicare SNPs must cover all of the services covered under Medicare Part A and Part B, and all services that Medicare considers medically necessary. Medicare SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital.  All SNP plans must provide Medicare prescription drug coverage.  Generally, you must get your care and services from doctors or hospitals in the Medicare SNP’s network.  You may need a referral to see a specialist. A list of questions to ask before joining a SNP is [url=https://www.medicareinteractive.org/get-answers/types-of-medicare-advantage-plans-hmos-ppos-and-more/medicare-special-needs-plans-snps/questions-to-ask-before-joining-a-special-needs-plan-snp?]available here.[/url]

    I hope this is helpful and again you are welcome to contact us for more information.

    Stephanie