According to the University of Maryland, there are more than 1 million people enrolled in Medicare in Maryland. Medicare is a federally-funded, public health insurance that has regulations that apply to all 50 states. Every state, including Maryland, has private Medicare plans that can fit different needs and cover different benefits. What plan is right for you? Read on to learn more about Medicare plans in Maryland, eligibility requirements, and how to apply.
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Original Medicare consists of Part A, which is hospital insurance, and Part B, which is medical insurance. Neither Part A nor Part B covers prescription drugs, except in limited circumstances. If you need prescription drug coverage, you’ll need to enroll in either a Medicare Part D plan or a Medicare Advantage plan with a prescription drug benefit.
Everyone has different needs when it comes to their healthcare. For example, some people may have limited incomes, and they might prefer a plan with a low premium that offers a lot of additional benefits. Other people might be more financially sound, and they may want a plan that offers increased flexibility and a larger provider network. Two types of private Medicare plans in Maryland are Medicare Advantage plans and Medicare Supplement plans.
Medicare Supplement (Medigap) plans work differently than Medicare Advantage. It’s crucial to know the difference between the two because you cannot have both at the same time. Medigap plans cover financial items such as coinsurance and copays. In 2020, there are eight different “letters” of Medicare Supplement plan. Each letter covers different services.
Medicare Part D plans, also called prescription drug plans (PDP), can help pay for the medications you take at home. Typically, your plan will have a formulary that lists the drugs it helps cover.
The drugs are assigned to tiers, each of which will have a different cost. For example, your tier one drug may have a $5 copay, a tier two drug may be $30, and a tier three drug may cost $50. Different factors can affect how much your medication costs, like brand name vs. generic drugs.
Medicare cost sharing and how much you pay can depend on a variety of factors such as how long you or your spouse worked and your income.
Most people who receive Medicare coverage get “premium-free” Part A coverage. The Part B premium is $144.60 in 2020, and you may have to pay more depending on how much money you make.
Each Medicare Advantage plan has different costs for deductibles, copays, coinsurance, and out-of-pocket maximums. While you are still responsible for paying your Part B premium, your Medicare Advantage plan may offer low or $0 premiums and reduced copays.
Medicare Supplement plans can cover coinsurance and copays, but your monthly premium may be higher. Part D plans have premiums and deductibles, but you may only be responsible for paying 25 of both brand-name and prescription drug costs in the form of copays and/or coinsurance.
Most people are eligible for Medicare when they turn 65. However, you may be eligible for Medicare if you have certain chronic conditions such as ALS or ESRD, or if you’ve received SSDI for at least 25 months.
People who are eligible for Medicare due to their age have an Initial Enrollment Period (IEP) which allows you to enroll three months before your 65th birthday, your birthday month, and the three months following your birthday. You may owe penalties if you don’t enroll on time, so it’s best to act right away!
You must have Medicare Parts A and B before you can enroll in a Medicare Supplement, a Medicare Advantage plan, and/or a Part D plan.
Can I have both Medicare and Medicaid in Maryland?
You can have both Medicare and Medicaid if you qualify. Medicaid is a state and federally funded program that helps people who have financial needs find healthcare coverage. If you qualify for both Medicare and Medicaid, you may be eligible for a type of plan called a Dual Special Needs Plan (DSNP), which may offer low or $0 premiums, copays, and/or deductibles.
A DNSP may also qualify you for a Special Enrollment Period (SEP) which allows you to make one change per quarter from January to September. You can make changes to your coverage during the fourth quarter (October to December), but you must make the change during the Annual Enrollment Period (October 15 to January 7). Any changes you make during the Annual Enrollment Period (AEP) will take effect on January 1 the following year.
The DSNP SEP is a huge benefit because you may not be stuck with a plan that doesn’t meet your needs for very long. For example, if you elect a new plan on January 15, your new coverage will take effect on February 1. Keep in mind that many Maryland Medicare Advantage enrollees may have to wait until October before they can change their coverage.
You can apply for Medicare here. If you’d prefer, you can call 1-800-772-1213 or apply in-person at your local Social Security office. If you want to learn more about Medicare Advantage, Medicare Supplements, and/or Medicare Part D, a licensed agent with Medicare Plan Finder can help!
Our agents are highly trained and they can show you the available plans in your area and help you decide what might work best. Call 1-844-431-1832 or contact us here to arrange a no-cost, no-obligation appointment today.
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