Insurance Information

Overview Of Medicare And Private Insurance Plans

Are you covered by Medicare or a private insurance plan?

As you know, Medicare is available to people who have reached the age when they’re eligible for social security, while private insurance plans are intended to cover younger individuals, families and employee groups.

Medicare and private insurance plans work in similar ways. The plans pay a certain portion of the cost of treatment, drugs and medical devices, while the patients pay part of the cost, which is known as a copay. The amount of the copay varies with the insurance plan, treatment types, drugs and medical devices.

Generally, Medicare and private health plans have similar rules, but private plans can vary. For details of private coverage, you should consult the material that came with your health insurance plan.

Medicare Basics

When you reach the age of 65, you qualify for Medicare. At this time, it’s usual to transition from private insurance to Medicare, although some individuals elect to retain their private coverage in addition to Medicare.

There are exceptions to the age limitation. For example, if you’re under 65 but have permanent kidney failure, you can qualify after three months of dialysis. Or if you’re permanently disabled and are eligible for social security, you can be covered by Medicare after you’ve received disability benefits for 24 months.

Medicare FAQ’S

What Is Medicare?

Medicare is the health insurance plan established and run by the U. S. Government. It was created to provide health insurance for older Americans.

When Do I Become Eligible For Medicare?

If you’re 65 or older, you qualify for Medicare.

In certain instances, you may also qualify if you’re under 65; for example, if you’re permanently disabled and eligible for Social Security. In this case, your Medicare coverage can begin 24 months after your disability benefits start. You may also qualify if you have permanent kidney failure. In this instance, your Medicare coverage can begin 3 months after your dialysis begins.

What Are The Different Parts of Medicare?

Medicare Part A covers hospital stays, home healthcare and hospice services, while Medicare Part B covers physician visits, lab tests, ambulance services, and home medical equipment.

Medicare Part D covers drugs. Participation in the program is optional. We highly recommend that you elect to participate.

Do I Have to Pay a Premium For Medicare?

There is generally no fee for Part A. Instead, payment is due when you make use of the benefits.

Medicare Part B does require payment of a monthly premium, whether or not you make use of the services. The amount of the premium you pay varies with your income. It ranges about $115 a month to about $370 a month. You can elect to have the premium deducted from your Social Security check and most people find this option convenient.

Medicare Part D is an optional program that covers prescription drugs.There are different plans within Medicare Part D. The coverage, fees and copays vary with the plans.

There are also Medicare Supplement Plans, often referred to as Medicare Advantage Plans, which are administered by major private health insurance plans that have a Medicare contract.

Is Part D The Only Medicare Drug Coverage?

Generally, all drug coverage comes under Part D. However, some drugs are covered by Medicare Part B, including some nebulizer drugs, some infused drugs, certain immunosuppressive drugs, some oral anti-cancer medications, as well as most parenteral nutrition.

Want to know more? Ask us about your Medicare coverage or visit the official U. S. government Site for Medicare at

Helpful Medicare Resources

To help you with your Medicare coverage and the questions you may have, we’ve put together a library of resources for your easy reference.

It’s part of our effort to provide our customers with Total Care RX service.

Please, browse the resources for information that may be helpful to you.

If you have any questions about Medicare that aren’t answered here, we invite you to contact us. We’re here to help.

For a complete discussion of Medicare, you can also visit

Medicare Terms & Defenitions

It’s helpful to understand the terms that are used to describe Medicare. Sometimes, they can be confusing. The U. S. Government provides a complete glossary of terms at its site.

The terms are arranged in alphabetical order and there is an easy alphabet-based navigation bar at the top of the page.

For instance, if you have a question about benefits, just click on the “B” and a description of all the terms that begin with that letter will be listed with a definition

To access the glossary, just go to

Helping you understand Medicare is part of our dedication to providing Total Care RX pharmacy services to our customers.

If you still have a question about Medicare after consulting the glossary, we invite you to contact us. We’re here to help.

Medicare Coverage Gaps

Most Medicare drug plans have a coverage gap, which is a temporary limit on the amount the plan will cover.

The gap only begins after you and your plan have spent a certain amount for drugs.

If you get Extra Help to pay Part D costs, you won’t be affected by the gap. Extra Help is available to people who receive Medicaid.

When you enter the coverage gap, you receive a 50% discount on covered brand-name drugs. The discount is paid by the drug manufacturer. The remaining 50% counts as out-of-pocket spending, which helps you get out of the coverage gap.

When it comes to covered generic drugs, you pay 86% of the plan’s cost for the drugs until you reach the end of the coverage gap.

Certain other items count toward the coverage gap, including your yearly deductible, coinsurance, as well as your copayments. Other items don’t count toward the coverage gap, including the drug plan’s premium and the amounts you pay for drugs.

Ways to Lower Your Costs in the Coverage Gap

Talk to your doctor or other healthcare provider to make sure you’re taking the lowest-cost drug available that works for you.

Consider changing from brand-name drugs to generics.

Choose a Part D Plan That Offers Additional Gap Coverage. These plans may have a higher monthly premium.

You can find out if a Patient Assistance Program exists for the drugs you take by visiting Medicare’s Pharmaceutical Assistance Program site.

Want to know more? Ask us about your Medicare coverage or visit the official U. S. government Site for Medicare at