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The basics
Original Medicare is health coverage offered by the federal government. It includes Part A (hospital coverage) and Part B (coverage for medical services). After your deductible is paid, Original Medicare only covers 80% of your health care costs, making you responsible for 20%. There is no limit to the amount of money you could pay out of pocket as part of that 20%.
Medicare Part C, also called a Medicare Advantage plan, is an all-in-one alternative to Original Medicare offered by private companies like Priority Health. If a Medicare Advantage plan also includes Part D prescription drug coverage, it is called a Medicare Advantage with Prescription Drug (MAPD) plan. You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.
What will it actually cost?
Some Medicare Advantage plans, including several offered by Priority Health, have a $0 monthly premium. However, you will still have some health care expenses.
Medicare Part B premium: Regardless of what you pay each month for your Medicare Advantage plan, you will still have to pay your Medicare Part B premiums to the federal government.
Deductibles: In many cases, Medicare Advantage plans will have a deductible that must be met before the plan will begin to pay. You’ll be responsible for your health care costs out of pocket until you’ve reached your deductible.
Co-payments: Medicare Advantage plans, regardless of monthly premiums, will charge co-payments. This means you’ll have to pay a small share of health care costs when you receive care, while your insurance pays the remaining costs. This holds true even once you’ve reached your deductible.
Prescription Drug Costs: Some Medicare Advantage plans include prescription drug coverage. Each plan has a list of drugs that it covers and various out-of-pocket expenses for these drugs. Depending on the prescriptions you take, it’s important to look for a plan that best meets your needs and budget.
With a Priority Health Medicare Advantage plan, you’ll pay $0 for a 90-day supply of tier 1 (also called preferred generic drugs) when filled at a preferred pharmacy. You’ll also pay $0 for a 90-day supply of tier 1 and tier 2 (also called generic drugs) drugs when filled through mail-order with Express Scripts.
Is a $0 Medicare Advantage plan right for me?
A $0 Medicare Advantage plan can lower your out-of-pocket costs with predictable copayments, lower deductibles and out-of-pocket maximums. Most Medicare Advantage plans also offer extras such as vision, hearing and dental coverage, mental health support, fitness memberships, an over-the-counter allowance and coverage when traveling.
There is often a trade-off between monthly premium and deductible and co-payment costs with any health plan. Typically, the lower your premium, the higher your deductible. This means you may have a higher deductible with a $0 Medicare Advantage plan than with other Medicare Advantage plans. Don’t forget to add your prescription costs into the mix, too.
A $0 Medicare Advantage plan may be right for you if:
- You want predictable copays, deductibles and an out-of-pocket maximum.
- Paying a lower monthly premium is important to you.
- You want Part D prescription drug coverage bundled with Parts A and B coverage (included on MAPD plans).
- You want additional coverage for pre-existing conditions.
When can I enroll?
Here are the important dates and terms you need to know when it comes to enrolling in a Medicare Advantage plan.
Initial Enrollment Period — The three months before your birthday, during your birthday month and the three months after your birthday is called your Initial Enrollment Period (IEP). During this time, you can apply for Original Medicare (Parts A and B), a Medicare Advantage plan (Part C) and/or prescription drug plan (Part D).
Annual Enrollment Period — Oct. 15 through Dec. 7 of each year is the Annual Enrollment Period (AEP). If you have Medicare Parts A and/or B or are already enrolled in a Medicare Advantage plan or Part D prescription drug plan, the Annual Enrollment Period (AEP) is when you can switch to a different plan or health insurance provider. Your new plan benefits take effect on Jan. 1 of the upcoming year.
What if I still have questions?
You have lots of options when it comes to Medicare; you may also have lots of questions. Priority Health’s customer service team was recently named to Newsweek’s America’s Best Customer Service 2024 List(1) and would be happy to answer any questions you have. Call toll-free at 888.389.6648 (TTY 711), seven days a week, 8 a.m.-8 p.m.
