Overview

We provide superior service to our Medicare Supplement clients from Lancaster to Indian Land and throughout the Carolinas. A Medicare Supplement plan, also known as a Medigap policy, is designed to help pay for some of the costs that original Medicare does not cover. Medicare supplement plans are offered by private insurance companies and available to individuals who are eligible for Medicare. A Medicare supplement plan will help limit out-of-pocket medical expenses such as copayments, coinsurance and deductibles.

There are 11 standardized plans labeled Plan A through Plan N. Each one of these standardized Medigap policies provide the same benefits to the individual. Some of the Medigap plans can also offer additional benefits such as skilled nursing facility coinsurance and foreign travel emergency care.

  • Doctor Choice – Individuals can select their preferred doctors and hospitals, (so long as they accept Medicare patients). Individuals can see specialists without needing a referral.
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  • Convenience – Virtually no claim forms to file.
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  • Guaranteed Renewals – Medicare supplement plans are automatically renewed, so long as individuals continue to pay their premium on time, without misstating one or more material facts upon initial enrollment.

Medicare Supplement Plans

How do I get a Medicare Supplement Plan?

In order to get a Medicare Supplement Plan you must have Medicare A and B. You must continue to pay your monthly Part B premium in addition to your monthly Supplement plan premium. You can obtain this plan during your Medigap Open Enrollment Period, which is the six-month period starting in the first month you are 65 years or older. During this period, you cannot be denied coverage on account of a past or current health issue.

If you are interested in learning more about how to obtain a Medicare Supplement Plan, contact the office at 803.286.1161 x1 or send us a message form our Contact Page.

 

What Does a Supplement Plan Not Cover?

Plans sold in 2006 or later do not include prescription drug coverage. Individuals will need to purchase a stand-alone Part D plan in addition to their supplement plan to get prescription drug coverage.

Part D Prescription Drug Plan

Anyone on Medicare (with either Part A or Part B) is entitled to drug coverage (known as Part D) regardless of income. No physical exams are required. You cannot be denied for health reasons or because you already use a lot of prescription drugs.

Drug Coverage

How do I get Medicare prescription drug coverage?

You must enroll in one of the private insurance plans that Medicare has approved to provide it. Wherever you live, you can get drug coverage in one of two ways:

  • Through a “stand-alone” plan (PDP) that offers only drug coverage. This type is mainly intended for people who choose to receive their other health benefits from the traditional Medicare fee-for-service program.
  • Through a Medicare Advantage plan (MA-PD) that covers both medical services and prescription drugs. This type is for people who choose to receive all their Medicare benefits in one package, usually through a health maintenance organization (HMO) or a preferred provider organization (PPO).

 

If you are interested in learning more about how to obtain a Part D prescription drug plan, contact the office at 803.286.1161 x1 or send us a message form our Contact Page.

What will I pay for my drugs?

Cost of drugs

You could pay a different price for the same drug according to the phase of coverage that you’re in at any point during the year.

 

  • Deductible: If your plan has a deductible, you pay full price for your drugs until the deductible amount is met and coverage kicks in. “Full price” means the price your plan has negotiated with each drug’s manufacturer. This price may be less that you would pay retail at the pharmacy.

 

  • Initial coverage period: Your share of each prescription is either a flat copayment (for example, $20) or a percentage of the drug’s cost (for example, 25 percent). Most plans have three or four levels (known as “tiers”) of copays, rising in price from the least expensive generic drugs through “preferred” brand-name drugs to “nonpreferred” brands and finally to specialty or high-cost drugs.

 

  • Coverage gap (“doughnut hole”): In 2016 you pay 45 percent of your plan’s price for brand-name and biologic drugs in the gap and 58 percent for generics. In 2017 you pay 40 percent and 51 percent respectively. Fifty percent of the discount for brand drugs is provided by their manufacturers; the rest of the discount for brand drugs and the whole discount on generics is provided by the federal government. If your plan provides any coverage in the gap, these discounts are applied to your remaining costs.

 

  • Catastrophic level of coverage: Your share of each prescription is about no more than 5 percent of the cost of the drug. You would also pay a different price if you receive Extra Help or have additional coverage from elsewhere (such as retiree drug benefits or assistance from a state pharmacy assistance program).

 

If you are interested in learning more about how to obtain a Part D prescription drug plan, contact the office at 803.286.1161 x1 or send us a message form our Contact Page.