If you are turning 65 in the next few months, you have choices to make concerning your Medicare coverage.  Do you think a Medicare Supplement will be better coverage? Will you consider enrolling in a Medicare Advantage plan? If you’re still working and have employer coverage, do you even need to enroll in Medicare?

Here is some information to get started in understanding your Medicare choices:

MEDICARE ONLY: You will be responsible for the Part A hospital deductible and other co-pays. You will pay the Part B deductible. You will be responsible for 20% of the bills for doctor visits and services, lab tests, emergency room treatment, ambulance, chemotherapy, radiation therapy, physical therapy, and most medical care you receive outside a hospital.  THERE IS NO CAP TO YOUR 20% CO-INSURANCE.   Having just Medicare is risky because your medical bills can be overwhelming. The Medicare Part B premium is $99.90 per month.

MEDICARE SUPPLEMENTS: These work with your Medicare to give you more complete coverage. Also known as “Medigap ” plans, these fill the gaps in Medicare, some of which I listed in the previous paragraph. A Medicare Supplement Plan F will generally leave you with no medical bills because Medicare will pay first and your Plan F Medicare Supplement will pay the balance of the bills after Medicare has paid.  I always say, “think FULL coverage when you think of PLAN F”.

Medigap plans are named by letters: A, B, C, D, F,  G, K, L, M, N   and each one covers the gaps in a slightly different way. Because Plan F offers the fullest coverage, it has the highest monthly premium.

Plan F in Arizona will cost between $110 and $136 per month, depending on the company.  A Plan F is exactly the same from company to company. Beware of companies offering low premiums. They start out with the lowest premium and then raise the rate 30% or more the next year – and perhaps every year.  If you end up with health issues, you might not be able to change to a lower-priced Medigap plan in the future.

MEDICARE ADVANTAGE:  These are private Medicare plans offered by insurance companies, and they replace your Medicare. If you enroll in an Advantage plan, you won’t use your Medicare card because Medicare doesn’t pay your bills.  You will use the card given to you by your Medicare Advantage (MA) plan and your MA plan will pay your bills.  Many MA plans in Arizona have a $0 premium, though you must pay your Medicare Part B premium ($99.90/month). You will have co-pays for every medical service. For example, you might pay $15 when you see your primary care physician.  And you might pay $45 to see a specialist. Then there are hospital co-pays, emergency room co-pays, co-pays for labs, x-rays and other services.

Each Medicare Advantage plan is different, so you need to compare plans’ co-pays, doctor and hospital networks, and how they cover your drugs.

PART D: This is the drug plan which Medicare wants you to have (and pay for). If you get a Medicare Supplement, you should also sign up for stand-alone Part D plan.   Part D is offered by insurance companies that are contracted with Medicare.  Each Part D plan has a different monthly premium and a different formulary (list of drugs covered). Stand-alone Part D premiums range from $15 to $90 per month.

If you enroll in a Medicare Advantage plan with $0 premium, you get Part D at no additional cost.

Before signing up for a Part D plan or a Medicare Advantage plan with Part D included, you need to be sure your drugs are covered by that plan and what your co-payment will be.

STILL WORKING: If you are 65, working, and have good employer health insurance, you might not need to enroll in Medicare and pay the Part B premium ($99.90/month).  If you work for an employer with fewer than 20 employees, Medicare should be your primary insurance. If you work for a slightly larger company, you need to compare Medicare with your employer coverage. Small business health insurance often has high deductibles and high premiums. Medicare might be a better choice than your employer’s coverage.

You can see a video explaining these choices by clicking here: Intro to your Medicare choices

HOW TO PICK A PLAN

If you’ve decided to go with Medicare Advantage, you have quite a few plans to choose from. You need to check to see if your doctors are in the plan’s network and how your drugs are covered and at what cost.  This is what I do for my clients and sometimes it’s a lot of work.

If you’ve decided on a Medicare supplement, the only difference from company to company is the premium – although some companies raise their premiums more than others.

If you need a stand-alone Part D, you’ll need to compare plans (30 in Arizona) and figure out which one will cost you the least amount of money – and covers all your prescriptions.

Call me if you have questions or need help with your Medicare choices: 520-820-8639

This entry was posted on Thursday, April 5th, 2012 at 8:35 am and is filed under Health. Tags for this post: Medicare Advantage, medicare choices, medigap arizona tucson, part d, turning 65 medicare. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.