One of the services of my agency is to assist those who are aging in to Medicare with the daunting task of sorting through the copious amount of information being stuffed into their mailboxes prior to their birthday. Having to recertify every year to offer and enroll folks into Medicare benefits, the first thing to know is the most important information to keep and review is everything from Social Security. Every other piece of mail you will receive will be some sort of junk mail advertising.
Traditional Medicare coverage is made up of 4 separate and distinct coverage types. They are:
Part A – Hospitals
Part B – Doctors (Approx. $115 per month depending on earnings – comes out of your ss check)
Part D – Prescription Drug Plan
Part A & B cover 80% of all medical expenditures so the 4th piece is:
Medicare Supplement offered by private insurance carriers – Covers the 20% that A & B does not.
What is important to understand is that while the Medicare Supplement is offered by private insurance carriers, they are all mandated by Center for Medicare & Medicaid Services to cover the exact same thing. So whether you choose United Health Care AARP, or Aetna AAA, you are receiving the identical plan design and coverage. The most comprehensive of the supplements is Plan F, where the client has no out of pocket expenses for any medical service rendered at a Medicare accepted facility. Currently the most economical Plan F in CT is with United Health Care priced at $241.50 per month. If you can handle some small out of pocket expenditures, such as the $166 Part B deductible, and $20 copays for office visits, then Plan N would be for you. Anthem offers this plan in CT for $147 per month. These two supplement plans are by far the most chosen amongst our clients. The final piece of this traditional Medicare coverage option is you must enroll in a Part D Drug plan. If you are not taking any medication, or are on a simple generic prescription, then opting for the least monthly expensive plan would make sense. However, if you are on several medications, or taking insulin, or other injectable medications, then you should certainly utilize the Prescription Formulary finder on Medicare.gov. Simply plug in all of your medications and dosages and the system will return copious choices for you, but lead with the most overall economical way to purchase your medication at the present time. These plans may or may not feature deductibles, and are priced differently. What you want to focus on is the estimated annual cost of procuring your medication.
Keep in mind this Traditional Medicare coverage is essentially a nationwide plan as all providers who assign to the Medicare re-imbursement schedule will accept this insurance coverage.
Do you have another option for your Medicare Coverage? Yes you do, and that lies in the world of Medicare Advantage.
Medicare Advantage incorporates Part A, B, D, and your supplement all under one roof. These plans are defined as including all of the benefits including in the traditional approach above, as well as some extra services provided by the plan. Further, these policies feature lower premiums, and in some cases no premiums at all. What’s the catch you say? Glad you asked. First, while lower or no premiums are great, these policies feature out of pocket expenses in the form of copays for office visits, diagnostics, hospitals, etc., with an annual in-network max out of pocket of $6700. Out of network out of pocket exposure is $10,000.
This is a nice Segway to the second and most problematic issue with Medicare Advantage, as these programs are network driven. That is to say, one must find a physician that contracts with these carriers and the chosen plan within their portfolio to ensure in-network coverage. In 2013, one carrier dropped hundreds of doctors from their program, leaving members scrambling to find another physician. Now, for those clients that simply do not have the means to purchase Plan F or N, and are in need of assistance, then these policies can and will make sense.
Both options provide for comprehensive Medicare insurance albeit with different delivery services. The most important thing to do is to analyze your needs, and discuss them with a professional either with our agency, or someone who does what we do, so that you know exactly what you are enrolling in.