This high level overview and will not address every situation that a Medicare beneficiary may find them self in. This short primer is meant help you understand the different parts of Medicare and how they work, or don’t work, together. The following information can also be found in the Medicare and You Handbook.
The Affordable Care Act set in motion a series of reforms to slowly close the coverage gap or “donut hole” that Part D members faced after they met their initial coverage dollar amount. Pharmaceutical manufacturers that wanted their Brand name drugs covered in the gap had to sign an agreement with Medicare to cover 50% of the cost of the drug. Medicare has had to assess civil monetary penalties on many companies that failed to cover the discount.
The federal government pays the insurance company that administers the Medicare Advantage plan every month just like paying an insurance premium
Overall, the ad “thanking” Dan Lungren for fighting against new taxes on Medicare is extremely deceiving. H.R. 2190 proposes no new taxes.
How can anyone make an informed Medicare decision when they are only presented with options from one insurance company?
The Center for Medicare and Medicaid Services publishes a variety of documents outlining how much they reimburse Medicare Advantage and Part D Prescription Drug plans. Below is the monthly reimbursement rate for Medicare Advantage plans known as the capitation rate. This is only for California counties. The capitation amount is only for the medical portion of the Medicare Advantage health plan. There is a separate amount if the plan includes prescription drug coverage.