Simple Talk on Medicare Plans

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Are you turning 65 and going on to Medicare? Or have you been on Medicare, had a Medicare Plan and really do not know how the plan would work for you?  You aren’t alone.

Often people do not understand how Medicare and how the coverage they have works.  Most often you hear this when someone has a medical event, is hospitalized, receives chemotherapy, or is prescribed an expensive prescription drug.  This is a tough time to learn how (or if) your plan covers these expenses and if they cover the doctors you wish to use.

It is good to know your basic options.  People going onto Medicare have two very basic options: they can stay with “Original Medicare”, buy a Gap-filler (also called a Medicare Supplement) and a Part D drug plan; or they can buy a Medicare Advantage Plan (MA).  An MA is where a private insurance company contracts with CMS (Medicare), establishes your plan benefits (must be at least as good as original Medicare), pays your claims, and provides your plan’s service. MAs orientated in the 1990s with the concept that a private insurance company could be more efficient and cut costs over original Medicare.  Therefore, people could have better benefits at a lower cost. It is important to know that MA plans are not Medicare supplements or Gap-fillers.

Original Medicare originated in 1965 and has provided security for seniors and the disabled for years. If one chooses to stay with Original Medicare they should consider a Medicare drug plan also.  These MedicareRX Plans are also called Medicare Part D plans.

There are reasons why a person may choose to enroll in a Medicare Advantage Plan. They may be healthy, have a nest egg to help them pay any out of pocket costs and want to pay a lower premium.  Or they may be in their twilight years and not wish to be aggressive with care. In either case, when buying the same MA plan, whether on Medicare disability age 45, aged into Medicare at 65 or now age 95; their premiums are the same. Qualified people of any age or health would pay the same premium.

It is also important to note: different insurance companies offer different plans. MA Plans, networks and premiums vary from one company to the next.  Most MA plans have networks so you need to be sure your providers are in network, or know whether the plan pays out of network benefits.

On the other hand, Medicare Gap-fillers may be less expensive at age 65 than 95. They may also provide spousal discounts if both apply. Gap-fillers are standardized so that every company offers from the same plans, but company service and plan pricing is different company to company.  Often people buy Plan F or Plan G.

As mentioned earlier, if a person chooses a Gap-filler they should also strongly consider a MedicareRX plan.  These plans vary greatly in their drug coverage, restrictions, network pharmacies and premiums. There is a science to locate the plan to cover your prescriptions and pharmacy at the lowest projected out of pocket costs.

So “simple talk about Medicare Plans”? Not really; it truly can be complicated and each person’s needs can be different.  Not only can it be costly if you end up on the wrong plan, you may not be able to see the provider you want to see. A 45 minutes meeting can remove most all of the confusion.  Get professional help from a local, experienced agent.  Best yet – you do not pay extra for this help and it could literally be a life saver.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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