The health care exchange is open for every U.S. resident, but only the uninsured will face penalties for skipping out. If you are enrolled in your employer's health plan or pay for your own plan already, you can continue with that plan as long as it is offered. You may or may not find insurance less expensive through your state insurance exchange.
With the creation of the Insurance Markeplace under the healthcare reform act, the search for individual and family insurance plans has become more difficult for most individuals. Before the creation of the federal/state "Marketplace" one could simply search for and apply for health insurance the an agency website. Some companies opted to offer plans through this new marketplace and so individuals will need to now search these "Marketplace" websites as well if they wish to find as many plans as possible. In many markets, the large health insurance companies have selected a "wait and see" approach and their plans will still be available directly through agents. The insurance plans in the "Marketplace" will be handled by unlicensed "advisors".
In Wisconsin, one easy to search site is rra4ins.com. Here you can Research, Refine , and Apply for health insurance all on one site. For other states, many people choose to use this site. You will not find "Marketplace" plans on these sites due to the restrictions placed by the Healthcare Reform Act.
A Medicare Advantage Plan combines Medicare Parts A and B and often includes Part D. Most if not all of the premium for these plans is paid for by Medicare. These plans are contracted with Medicare and the plans pay portion that Medicare would typically to the doctor and hospital. A member of these plans typically pays a fixed copayment for medical care instead of the standard Medicare deductibles and 20%.
Since most Medicare Advantage plans include prescription drug coverage (Part D), it is not necessary for member of these plans to obtain a separate Part D coverage.
Medicare Part D plans are the prescription drug plans designed to go with Medicare. These plans follow a basic format dictated by Medicare. Medicare recipients typically pay a premium ($15 to $100 depending on plan) for these plans unless the Part D portion is included with their Medicare Advantage Plan or the premium is paid for by Medicare/Social Security ("Extra Help" or Low Income Subsidy).
Deductible: plans may have a deductible of up to $325.
Initial Coverage: plans set co-payments for generic, brand name, and specialty drugs.
Coverage Gap: after you and the plan have paid a total of $2,970 since Jan 1, you begin to pay 79% for generic medications and 47.5% for brand name drugs.
Catastrophic Coverage: after the amount you pay plus the manufactures discount equals $4,750, you pay the greater of $2.65 or 5% for generic medications and $6.60 or 5% for brand name medications.
Mary has a plan with a $0 deductible. She takes 4 medications which have a ful cost of $193 per month. From January through December her total yearly drug cost will be 12 x 193 = $2,316. Mary will not reach the coverage gap and therefor will only pay the standard co-payments throughout the year.
Robert has plan with a $325 deductible. He will pay the deductible from his own pocket but will benefit because his plan has a very low premium and low co-payments. Robert's typical monthly cost for medications is just $40. He will pay the full $40 for his medications from January through August but in Sept he will have completed the deductible and will begin paying a small co-payment for his medications. He will not reach the coverage gap phase because after the deductible, he and the plan did not pay more than $2.970.
Paula takes some generic medications and some brand name medications. In January, Paula pays $100 in co-payments and the insurance plan pays $230. This will continue through September ($100 + $230 x 9 = $2,970). for the months of October through December, Paula will pay 79% of the full cost for her generic medications and 47.5% for her brand name medications.
Albert takes quite a few generic medications and some very expensive brand name medications. The total cost for his medications is $3,000 per month. He will pay co-payments in January but will be in the coverage cap phase in February. Because the manufacturer's is discount is credited toward Albert's out of pocket costs, he will pay 79% for generic medications and 47.5% for brand names drugs during February and part of March. When his percentage and the 50% manufacturer's discount for brand drugs totals $4,750, he will pay the greater of $2.65 or 5% for generic medications and $6.60 or 5% for brand name medications for the rest of the year.
Medicare supplement plans are private insurance plans designed to pay the deductibles and 20% co-insurance that Medicare does not pay for doctor and hospital care. A Medicare recipient must have both Part A and Part B of Medicare in order to have a Medicare Supplement plan. In most states, a Medicare recipient may choose from several different supplements labeled Plan A through Plan N. The premium for a Medicare Supplement s dependent on the amount of benefits in that plan.
Each company sets their own rates for their Medicare Supplement plans. Every Plan A has the same benefits, every Plan F has the same benefits, etc.