Frequently Asked Questions About Oregon Medicare Supplement Insurance and Oregon Medicare Advantage Plans
Do you have questions about Oregon Medicare Advantage Plans, Medicare Supplement insurance, Part D Prescription Drug Plans (PDP) or Howard Insurance for Seniors? Here are a few of the more common questions we are asked every day.
2025 Changes - Inflation Reduction Act
What is the IRA?
The Inflation Reduction Action Act (IRA) enacted in 2022 included certain changes to the Medicare Part D program.
The first change came in 2024 when beneficiary copays and catastrophic coverage went from 5% to 0%.
Changes for next year:
- For 2025, there are two more major changes. No more coverage gap (Donut Hole) phase! Just 3 phases of coverage for 2025. Deductible, initial coverage, and catastrophic.
- A new $2000 out of pocket cap on beneficiary Part D expenses.
How does this affect me?
While these changes were designed to save beneficiaries money on the high cost of prescription medications, Medicare enrollees will see different outcomes depending on their unique situation. Keep reading to see how these changes may affect you.
I have Medicare Part D drug coverage
- No more coverage gap/donut hole
- $2,000 out-of-pocket maximum on prescriptions
- Ability to pay prescriptions annually out-of-pocket in monthly installments
- Possible increased monthly premiums on your Part D plan
- Possible changes to planned formularies/covered medications
- Possible changes to prescription copays
What if I have a Medicare Supplement?
This does not affect you. Keep as is!
What if I have Medicare Advantage?
- No more coverage gap/donut hole
- $2,000 out-of-pocket maximum on prescriptions
- Ability to pay annual prescriptions out-of-pocket in monthly installments
- Possible increased monthly premiums on your MAPD plan
- Possible changes to planned formularies/covered medications
- Possible changes to prescription copays
- Possible changes to ancillary benefits
What can I do about these changes?
Read your plan’s annual notice of changes (ANOC) when it arrives in September. Your ANOC will outline the changes to your Medicare plan’s benefits so you can see how you are potentially affected. If you have any questions or concerns about what this will mean for you please contact us!
What is Medicare?
Medicare is a single-payer, national insurance program administered by the US federal government since 1966. Medicare is health insurance for people age 65 years and older; people younger than 65 receiving Social Security Disability Insurance (SSDI) income for more than 24 months; and people with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Medicare consists of two parts:
- Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
What is Medicare Part D?
Medicare Part D offers prescription drug insurance to all Medicare beneficiaries, regardless of income or health. Medicare Part D plans cover generic and brand name prescription drugs.
Private insurance companies contracted with Medicare offer the plans, which may require monthly premiums, co-pays, co-insurance, and deductibles.
Part D coverage is available through standalone Prescription Drug Plans (PDPs) that cover only drugs, as well as from Medicare Advantage with Prescription Drug (MAPD) plans that combine health and drug coverage.
If you want prescription drug coverage, you must take an action to enroll in a plan. We can help you with that.
Why would I want a Medicare Supplement Policy or Medicare Advantage Plan?
Medicare only pays about 80% of your medical and health care costs. The remaining 20% is up to you. People want and need to have additional health insurance to pay for their health care. We can help you determine which is a better choice for you: A Medicare Supplement Plan or a Medicare Advantage Plan; a stand-alone Part D, or combined Medicare Advantage Part D (MAPD).
Should I buy Medicare Supplement, Advantage Plans, or Part D through an Affordable Care Marketplace website?
No. The Affordable Care Marketplace website is for individuals, families, and employees of small businesses to get health coverage through either private insurance companies, or the Oregon Health Plan.
What is the best way to proceed?
Contact us today to set up a time to talk about your needs. We represent a number of different insurance companies and plans. We work for you – not the insurance companies. We can help you decide for yourself what is best for you and your family. Everyone is different. We have the options and expertise to help you make a wise decision.
What does it cost to use your services?
Our services cost you nothing. The various insurance companies we represent pay us a commission. Our time and work with you is at no cost to you!
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