MY MEDICARE OPTIONS
What Are My
Medicare Options?
You have two main coverage options for your Medicare Coverage
Original Medicare Parts A & B with a Medigap plan
Replace Original Medicare With a Medicare Part C Advantage Plan
Original Medicare
Medicare Part A & B
Medicare Supplement (Medigap) Plans
- Medicare Parts A & B are required
- Part D drug plans are purchased separately
Medicare Advantage Plans
- Medicare Part A & B are required.
- Part D drug plans may or may not be include on an Advantage plan
STEP 1
Time to make a choice
Supplement Medicare
If you choose to supplement your Medicare coverage, you may select one of the ten federally standardized Medicare Supplement plan (Medigap plans). Depending on the plan chosen, they can cover some or nearly all of the deductibles, co-insurance (the 20% part) and copayments under Original Medicare Part A & B.
Medicare Supplement plans are not network based like employer group or individual plans. You can see any provider in the US who accepts Medicare. You will never need a referral in order for Medicare to pay your claim.
Medicare Supplement insurance companies do not "medically manage" Medicare supplement plans. If Medicare pays the claim, then the insurance company pays based on the plan you have selected. They can not deny paying their portion of a claim if Medicare pays.
Medicare Supplement (Medigap) plans do not cover prescription drugs. You will need to purchase a separate Medicare Part D prescriptions drug plan if you want prescription coverage. We always recommend you purchase a Medicare Part D drug plan as there are permanent, increasing penalties if you don’t sign up for a plan when you are first eligible. Part D plans can be purchased for as little as $10 to $15 monthly and even if you are not on any prescription medications right now, we have seen antibiotics and eye drops that cost hundreds of dollars for a one month supply. It just makes good sense to include this with your coverage.
Replace Medicare
Part C of Medicare is an alternative to "Original Medicare". Part C plans includes a range of health plans that are administered by private insurance companies but paid for (in part) by Medicare. These plans, by law, must cover all the same services that would normally be covered by Parts A & B. They may also offer additional benefits like dental and vision coverage. In addition, these plans limit the amount you will pay annually for medical services. The "maximum out-of-pocket" cost allowed in 2021 was $7,550. Plans may have lower maximums.
Part C of Medicare Advantage plans will have a "network" of participating doctors and hospitals. You want to check and see if the physician(s) you are currently seeing participates with the plan. Depending on the Part C Advantage plan, you may be able to see out-of-network doctors but at a higher cost to you. Usually, if your physician is not participating and you don’t want to switch to an in-network physician, then you need to look at other company’s plans to see if your doctor is participation with one of them.
Part C of Medicare Advantage plans may or may not cover prescription medications. Please make sure to check the formulary (list of covered medications) to make sure that the prescriptions you are currently taking are covered under the plan. If the medications you are on are not covered by the plan, you may want to look at other plans for your coverage.
LAST STEP
Are you a "Do-it-yourself" TYPE person or would you like some help with this?
Did you know that the majority of Medigap and Medicare Advantage Plans are purchased over the phone with someone working at a call center or insurance company? It’s true, and we view this as a lost opportunity. We don’t mean it’s a lost opportunity for us – it’s a lost opportunity for you.
You have the right to work with a local agent or broker:
Someone who will be there to answer questions and take care of services issues for you - someone who can make this process far easier for you. Don’t miss the opportunity to start a relationship that can help you now and in the future.
Remember, the cost for a Medigap or Medicare Advantage plan is the same regardless of where or how you by it. You don’t pay any more for a local agent’s services than if you purchased the plan directly for the insurance company or a call center.
Doesn’t it make sense to buy from someone you know – who can sit with you, face-to-face – than some anonymous voice on the phone?
There is no other time in your life when health insurance is more important than when you are sixty-five and over.
