Medicare Options for Seniors

 

 

Medicare Options and Doughnut holes explained in simple language. What could be better?

 

 

A, B, C, D all over again.  We explain Part A, Part B, Part C, Part D, Medicare Supplement, Medicare Advantage and doughnut holes (it is not what you think it is).

We show you how each option works AND show you what to expect with each of your options.  We equip you with the information you need to make an informed decision.   You and your spouse may be better off with different Medicare health insurance plans.  We don’t want you to take our word, we show you comparisons of the different health plan options so you can make the informed decision.

AND we know VA and TriCare benefits so we can show Veterans comparisons too.

Like all independent agents, you don’t pay anything for us to show your options – the insurance companies pay agents. We believe you make better decisions when you can compare options.  We screen the companies and plans based on your needs and provide comparisons to help you make your decision.   We represent only companies that are properly licensed to offer insurance in Florida, some large some small.  

If you are getting ready to turn 65, are already 65 or if you are on Medicare disability, we have answers to your questions about Medicare and the many options you have.   Below are explanations of most Medicare options.   And downloadable informational booklets detailing Original Medicare, Medicare Advantage plans, Medicare Supplement (Medigap) plans, Part D prescription drug coverage, and L.I.S. assistance.

 

About Medicare

Original Medicare – Parts A and B

Eligibility is usually at age 65 or younger when you qualify for Medicare disability benefits.  You will receive a red, white, and blue Medicare card when you are eligible for Medicare.  Coverage is shown as Part A (hospital) and Part B (medical) coverage.  You can go to any doctor, hospital or other facility or supplier that accepts Medicare. You pay an annual deductible plus a set amount or co pay percentage for services received.  

There is not Out of Pocket Maximum with Original Medicare which is a big reason why people look to add other Plans to fill in coverage gaps.  Original Medicare Parts A & B are required if you want to add a Supplement or Medicare Advantage Plan.  

Medicare Advantage Plans – Part C

Medicare Advantage Plans are health plan options that must annually meet Medicare and State qualification requirements.  Although these plans are run by private companies, they are part of the Medicare Program, and are sometimes called “Part C.”  When you join a Medicare Advantage Plan, you are still in Medicare. These plans must provide all Part A and Part B coverages and be actuarially equivalent to Original Medicare.  

Medicare Advantage Plans can charge different premiums and have different provider networks, formularies, and costs of services, so it is important to compare plans before you join.  Further there are several versions (HMO, POS and PPO) that direct how you use the plan – ability to see doctors out of network, prior approval requirements, referrals, etc.  

Advantage Plans generally offer extra benefits and often include (Part D) prescription drug coverage.  In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.  If you enroll in a Medicare Advantage plan, you cannot purchase a Medicare Supplement or Part D prescription drug plan.

Types of Plans include:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point of Service (POS)
  • Special Needs Plans (SNP)

    Note: Medicare Advantage plans usually re-evaluate benefit packages each year. Plan designs and benefits are released in October for the upcoming years coverage. Check with your consultant for any changes in benefits or costs for the new year.

Comparison of Plan Types

HMO, HMO-POS and PPO, Part D and Medicare Supplements

HMO (Health Maintenance Organization)

It is an organization of healthcare providers that have contracted with an insurance company to offer their services at a fixed price.

HMO plans are more restrictive than PPO’s and HMO-POS plans.  You are usually required to select a primary care physician, who manages all aspects of your healthcare. The primary care physician must be a member of the HMO, so you may need to switch doctors.  To see a specialist, you are usually required to see your primary care physician first to obtain a referral.

The major advantage of an HMO is generally lower cost. Premiums (if there is one) co-payments, or co-insurances are typically very low, or cost free and are usually lower when compared to other types of plans.

HMO-POS (Health Maintenance Organization-Point of Service)

A Point-of-Service (POS) plan is an HMO plan that gives you the option to receive some services from doctors or hospitals that are not in the plan’s network, usually at a higher cost. POS plans (in most cases) offer the advantages of HMO plans, including prescription drug coverage in some plans.  Because there is the flexibility to see non-network providers, services may cost more than a standard Medicare Advantage HMO plan.  Always check your plan for details.

PPO (Preferred Provider Organization)

These organizations also contract with insurance companies.  PPO’s are more loosely organized and are not as restrictive as HMOs.

If you have a PPO, you can see any doctor that agrees to see you, but if you choose an out-of-network physician, you will pay a higher out-of-pocket cost.  You usually do not need a referral to see a specialist with PPO plans.

PPO’s typically cost more overall than HMOs and HMO- POS plans, but many people choose them because they are less restrictive. You will generally have more control over your own healthcare decisions than you would have under an HMO.

Medicare Supplemental Insurance

Medicare Supplement is the new term for Medigap policies.  Medicare insurance policies are sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage.

The standardized plans (A through M) range in benefits and therefore price.  Standardized means that all plans with the same letter cover the same benefits. For instance, all Plan C policies have the same benefits no matter which company you buy the plan from.  Premiums, however, vary.  Some plans offer benefits not covered by Original Medicare, like gym memberships and limited coverage outside the United States.  You pay a monthly premium based on where you live.  Medicare and the Medicare Supplements pay their respective shares of covered health care costs.

Each plan has a different set of benefits. You will want to talk to us before deciding which is best for you. 

Medicare Prescription Drug Plans / Part D

Medicare Prescription Drug Plans are offered by insurance companies and not original Medicare.    Generally, you pay co-pays for your prescriptions.  You will get a separate plan member card after you enroll.  You use this card when you go to the pharmacy to get your prescriptions filled. You will pay the co-payment and/or deductible, if any. If you have limited income and resources, you may get extra help (thru L.I.S. assistance) to pay for your Medicare drug plan costs.

Medicare Plans do not cover

  • Long-term care to help you bathe, dress, eat or use the bathroom
  • Vision or dental care
  • Hearing aids
  • Private-duty nursing