Mrs. gonzalez is enrolled in original medicare and has a medigap policy as well, but it provides no drug coverage. she would like to keep the coverage

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mrs. gonzalez is enrolled in original medicare and has a medigap policy as well, but it provides no drug coverage. she would like to keep the coverage she has but replace her existing medigap plan with one that provides drug coverage. what should you tell her?

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mrs. gonzalez is enrolled in original medicare and has a medigap policy as well, but it provides no drug coverage. she would like to keep the coverage she has but replace her existing medigap plan with one that provides drug coverage. what should you tell her?

Answer:

@LectureNotes, you’d need to inform Mrs. Gonzalez that Medigap policies, also known as Medicare Supplement Insurance, do not provide drug coverage anymore. Here’s a detailed explanation:

  1. Changes in Medigap Policies and Drug Coverage:

    • Since January 1, 2006, due to legislation changes under the Medicare Modernization Act, Medigap policies can no longer be sold with prescription drug coverage.

  2. Options for Mrs. Gonzalez:

    • If Mrs. Gonzalez wants drug coverage, she cannot get this through a Medigap plan. Instead, she has two primary options:
      • Enroll in a Medicare Part D Prescription Drug Plan (PDP):
        • She can keep her Original Medicare and Medigap policies but add a standalone Medicare Part D plan for her prescription drugs.
      • Switch to a Medicare Advantage Plan (Medicare Part C):
        • Medicare Advantage plans often include prescription drug coverage (MAPD plans) and other benefits. She could replace her Original Medicare and Medigap policy with a Medicare Advantage plan that includes drug coverage.

  3. Steps to Enroll in Part D:

    • Mrs. Gonzalez would need to review available Part D plans in her region and choose one that meets her prescription needs. She can research these plans using the Medicare Plan Finder available on the Medicare.gov website.
    • She should be aware of the initial enrollment period for Part D and the annual open enrollment period (October 15 – December 7) when she can join, switch, or drop a Medicare Prescription Drug Plan.

  4. Implications of Not Having Drug Coverage:

    • It’s important to inform her about the potential late enrollment penalty if she delays enrolling in a Part D plan without having other creditable prescription drug coverage. This penalty is added to her Part D premium for as long as she has Medicare drug coverage.

  5. Medigap Policy Considerations:

    • Mrs. Gonzalez should evaluate her current Medigap policy to ensure it meets her needs for supplemental coverage. While it won’t cover drugs, it still provides benefits like helping with coinsurance, copayments, and deductibles under Original Medicare.

Final Answer:
Mrs. Gonzalez cannot replace her existing Medigap plan with one that includes drug coverage because Medigap policies no longer offer drug coverage. Instead, she should either enroll in a standalone Medicare Part D Prescription Drug Plan or consider a Medicare Advantage Plan that includes prescription drug coverage.