Medicare Advantage 2024: Health plans with drug coverage
What’s in the chart
Type: This chart shows three types of health plans with drug coverage: HMO, PPO and HMOPOS. They are explained below. Counties served: Indicates whether plans are available in Hernando (Her.), Hillsborough (Hills.), Pasco and Pinellas (Pin.) counties.
Premium: Medicare recipients can expect to see an increase in their Medicare Part B premiums for 2024. The Centers for Medicare and Medicaid Services is projecting a rise from $164.90 in 2023 to $174.80.
Part B reduction: Some plans pay part of the monthly Part B premium. This “premium reduction” — also called a rebate or a “premium give back” — is considered an additional benefit offered by a plan. It’s usually returned to consumers in their monthly Social Security check. The chart indicates whether a plan offers a premium reduction. Since reductions can differ based on each beneficiary’s situation, please contact the insurer to find out the amount.
Drug deductible: In some plans, a deductible is paid before drug coverage kicks in. A drug deductible may not apply to all medications or tiers.
Doctor copay: This is the cost of every visit to the doctor. The first dollar figure is for primary care physicians; the second is for specialists. Costs are listed for physicians inside the network (Net) and outside the network (Out).
Hospital copay: This is the cost every time a patient is admitted to a hospital — both inside the network (Net) and outside the network (Out). For outpatient hospital coverage, refer to Medicare’s Plan Finder.
Yearly cost (Est.): Medicare’s estimated out-of-pocket costs under this plan, including the Part B premium and drug costs. It is based on an average person in good health but could vary greatly depending on the actual drugs and services needed. The best way to project costs is to use Medicare’s Plan Finder.
Out-of-pocket cap: The maximum of payments for the year inside the network (Net) and outside the network (Out). The lower the cap, the better.
IMPORTANT: These out-of-pocket limits do not apply to prescription drug costs.
Generics in the gap: Once you and your plan have spent $5,030 on covered drugs in 2024, up from $4,660 in 2023, you are in the coverage gap. Some plans may offer you lower costs in the coverage gap. The discount will come off the price that your plan has set with the pharmacy for that specific drug.
Rating: Medicare rates plans from 1 to 5 stars, based on customer satisfaction and certain health measures. The top rating is a 5. People with Medicare can switch into a 5-star plan at any time during the year, even if it’s not during an enrollment period.
What’s not in the chart
Private Fee for Service Plans (PFFS) and Special Needs Plans (SNPs): See explanation below and medicare.gov for details.
Medicare supplement plans: Also known as Medigap, this coverage helps pay some health care costs that Original Medicare doesn’t cover. Shop for those plans here.
Copayments for other services: Plans usually charge copayments for drugs, skilled nursing homes, ambulances, emergency rooms and many other services. Check individual plans for these details.
Goodies: Some plans offer some dental, hearing and vision coverage, exercise classes, transportation to the doctor and other extra benefits. Check plans for details.
Health plans without drugs: A few plans are cheaper because they do not offer drug coverage. Unless one has comparable coverage elsewhere, using these plans can result in stiff penalties if that person ever wants Medicare drug coverage in later years.
Health plans: how they differ
Medicare allows several types of private health plans, which cover all care. Here is how they differ:
HMO (Health Maintenance Organization): Generally requires the use of providers within a network. A personal physician usually coordinates care and may need to approve visits to specialists.
PPO (Preferred Provider Organization): Encourages the use of providers within a network, with low copayments, but also allows the use of providers outside the network at a higher cost. Usually allows the use of specialists within the network without prior approval of a personal physician. Some bigger companies allow the use of their PPOs in other states. Verify before signing up.
HMO-POS (HMO-Point of Service): A hybrid between an HMO and PPO. Usually requires staying within a network and may require the approval of a personal physician before seeing network specialists. It may cover some care outside the network. Some POS plans approve very little coverage outside the network, so check plans for details.
PFFS (Private Fee for Service): Has network, but allows members to get care outside the network if the provider will accept the plan’s payment, which many do not. Make sure provider will accept payment before incurring bills.
Special Needs Plans: People with certain chronic conditions like diabetes and COPD can sometimes qualify for a Special Needs Plan, which may include extra services for managing their disease. The consumer should make sure they qualify before purchasing. People living in nursing homes may also qualify for special plans, as can those on Medicaid.
Click here to see the standalone drug plans offered for 2024.
Read more about what you need to know about Medicare enrollment this year here.
