Medicare
Your Medicare health insurance plan choice may be the most important health insurance choice you make.
We all would love to live to be 100+ and be healthy as a horse so the saying goes, but that’s nothing we can bank on and more than likely we will need more help and healthcare services as we age.
The Medicare plan you choose will control which doctors and hospitals you can use to receive plan benefits, prescription drugs available and their out-of-pocket cost, the range of health benefits available from a physician or in a hospital, plan deductibles, coinsurance, and maximum out of pocket limits the plan provides.
NEW TO MEDICARE?
As someone new to Medicare you might initially feel a bit confused. The terminology Medicare uses is different from what other health insurance policies use. Just understanding what parts A, B, C and D represent is a little challenging and then understand when you can make changes and the rage of benefits the many plans available offer could make your head spin.
Add to that the amount of mail and all the “too good to be true” sounding TV commercials playing through open enrollment will make you feel concerned about making the wrong choice. You are not alone! We can help.
The solution has two basic parts. If you haven’t already, follow this link and read through the Medicare and You Handbook that Medicare provides. It does a good job of overviewing the program, general benefits, and your rights. The booklet does not specifically guide you to the best plan for you. It can’t, there are hundreds of plan variations from coast to coast. Use the booklet to help understand the program and what questions to ask about plans you have available in your area.
The second step is to consult with an experienced, trustworthy, independent licensed agent. They are out there. We like to think we are on that list.
As a third source, you can also ask trusted friends currently in the Medicare program what they chose and what their experience has been. Keep in mind that we are all different and our needs and experiences will reflect those differences which in turn effects our perception of service. In other words, take what they say with a grain of salt.
If you are interested in a Medicare Supplement insurance plan now, or in the future, know that unless you apply during your guaranteed issue period, the insurance company will underwrite your application. They ask health history question and may or may NOT accept your application for Medicare Supplement insurance. Take the time to understand this rule.
ANNUAL MEDICARE ADVANTAGE REVIEW
If you've chosen a Medicare Advantage plan, those are plans that typically have an HMO or a PPO network. These plans can change each year. Sometimes benefits can increase which improves the plan and other time they can drop or lower certain benefits. The plan network of doctors and facilities can also change from year to year and even mid-year. Prescription drug formularies can also change which might result in having to adjust your regiment and absorb higher out of pocket costs.
The takeaway here is that you must pay close attention to change notices the plan provides each year and certainly be proactive and reassess your plan choice if you have a change in your health.
An annual review with your agent is a practical approach. Medicare advantage plan enrollees can change their plan during Medicare’s Annual Enrollment that runs from October 15 through December 7 each year. Other change windows exist, talk with your agent about your options.
MEDICARE SUPPLEMENT INSURANCE
Medicare Advantage plans can be a great way to have a Medicare plan with a combination of medical doctor, hospitalization, and prescriptions drug coverage all in one. Advantage plans are required to incorporate standard Medicare part A and B coverage as their baseline. Many plans also include part D, prescription drug coverage. These are considered MAPD plans.
Advantage plans improve on baseline Part A and B benefits typically by providing lower copays and/or deductibles. They also add additional benefits to that plan benefits. Some insurers add a degree of dental coverage, others include a significant dental benefit, or include hearing aid benefits, transportation to services, gym programs, over the counter allowances and other benefits. And there are plans with part B rebates. That’s where a portion of your Medicare part B premium is credited back to you. This is one way they attract and maintain members. Make no mistake, the correct package of additional benefits can be valuable.
However, the main difference between Medicare Advantage and traditional Medicare is that Advantage plans use provider networks as an HMO or PPO network of: doctors, hospitals, outpatient care, blood and other test centers, and even prescription drug stores. HMO plans require you to use a network provider unless in an emergency. PPO plans include a network doctors and hospitals, etc. but they also allow you to use out of network providers but at a higher cost sharing rate.
This section is titled Medicare Supplement, so why are we talking about Advantage plans? That’s to better contrast them with Medicare Supplements.
Original or what is also referred to as Traditional Medicare, parts A and B, pay for healthcare benefits at any Medicare approved doctor or facility. You do not have to request approval to see a specialist. That’s your decision, maybe with the help of your doctor but you do NOT need to get a referral. If you wanted to travel cross country to see a certain specialist or get care at a certain hospital your Medicare insurance will pay standard benefits as long as the doctor and hospital accept Medicare. That’s wonderful, freedom of choices.
What’s the downside of using Original Medicare?
Original Medicare has copays, deductibles, and limits that can make your out-of-pocket cost for healthcare significant. Let’s call these gaps in coverage. You also would have to buy a separate prescription drug plan as you join Medicare or else pay a lifetime penalty for the period you were without coverage when you eventually enroll in prescription coverage.
Medicare Supplement insurance is standardized coverage that is designed to fill gaps in coverage Original Medicare has. Plans, for example an F plan provided by one insurance company provides exactly the same benefits as F plan insurance provided by another.
Premiums however will be different, the customer service you receive may be different, the stability of your plan premiums may also be different. By premium stability we are referring to the amount of plan premium changes made historically. We all understand that history is history and may not be a solid indicator of the future but it does have some relevance. That’s why we believe it’s a good practice to ask your advisor for some plan rate history information.
We have been helping people chose a quality Medicare insurance plan from day one, back in 2008 and would be pleased if we could explain your options and enroll you in the right plan. As an independent agency representing many of the major insurance companies, we are well versed and capable of helping you.
Please call with your questions today.