Cutting Through the Noise & Medicare Chaos
Updated: Nov 2, 2022
Navigating through the Medicare enrollment and multiple plans that fit your needs can seem like an overwhelming process. And, making the right choices can make the difference between smooth sailing or a rocky start. Most private insurance carriers offer different plans that complement or supplement your coverage with Original Medicare. Guidance on how the plans work and putting the right plan in place is what I do. Helping to answer your questions and assisting with the enrollment process is more than a one-time decision. This is a year-round service I provide, and I never charge a fee for the consultation.
Let’s start with some Medicare 101 basics:
Once you are enrolled in Medicare A & B, there are several options to enhance your benefits…Medigap plans (aka Supplementals), PDP part D drug coverage, and Medicare Advantage Plans. There can be cost associated with some and ZERO with others. This is where I differentiate my service from the mountains of direct mailers and spam callers trying to convince you THEY have the best benefit.
Let’s take an overview of each of these options:
Medicare Supplementals (aka Medigap)
Medicare Supplemental plan helps cover the 20% for some services that are not fully covered under
original Medicare parts A & B. They cover the gaps to help pay deductibles and co-insurance that is not covered under Original Medicare. These plans are regulated by Medicare and sold by private insurance carriers. These policies protect you from high out-of-pocket costs that could be incurred if you received medical treatment under original Medicare. Medicare supplement plans have standardized benefits, such as Plans A, B, G, F, K, N, etc. Since 2020 most of my clients who become Medicare eligible after that date tend to purchase Plan G, some high deductibles G, and a few Plan N. Medigap plans do not have a specific network of doctors, therefore, you can see any doctor nationwide that accepts Medicare. All supplemental plans have a monthly premium. Call my office for current rates.
Medicare Part D Drug Coverage
The “Part D” of Medicare, is prescription drug coverage, just simply remember D is for drugs! There are four main types of part D plans: PDPs (Prescription Drug Plans), MA-PDs (Medicare Advantage-
Prescription Drug plans), Medicare Cost Plan, and MSPs (Medicare Special Needs Plans). Part D
premiums vary based on the plan’s specific details. For instance, a higher priced plan may have lower co-payments for more expensive medications, but this is not always the case. Purchasing a lower-priced plan does not mean it won’t cover as many drugs as a more expensive plan. The key is to enter your current medications before enrolling in a plan, so you can see how much your refill costs will be. If you need help, R2MA can assist. Most drug plans have a deductible, this amount varies from one plan to the next. The deductible must be paid before the plan starts to pay, typically; low-tiered (generic) medications are not subject to the deductible.
Most of the drug plans have pharmacies they partner with, when you use a preferred pharmacy, it
allows you to pay a lower amount for your refills. If you choose not to use a preferred pharmacy, you will likely pay more for your refills. Learn more about part D drug plans here. According to the Social Security Administration, if you meet certain lower income levels, you may qualify for extra help paying your monthly premiums and prescription cost. You must apply directly with your state Medicaid office to qualify.
Medicare Advantage Plans…true about the advantages and disadvantages!
I hear a lot of rumors and misleading information surrounding Medicare Advantage plans. These plans started in the late 1970’s and have gone through several significant changes. The program became officially called “Medicare Choice” with the passing of the Balanced Budget Act of 1997 and renamed Medicare Advantage in 2003. This program is intended to help reduce cost, simplify, and provide more available services to seniors. You may have family, friends, or neighborhood with negative experience with Advantage plans, but over the last several years these plans have become very popular! That’s why, you need a licensed agent to navigate all the plans options, covered prescriptions, and additional benefits. R2MA has the resources and experience to guide your decision. Your doctor, pharmacist, and other medical professionals don’t have the access or time to give you a clear assessment of all the plans available to you. Medicare Advantage plans are offered by private insurance companies, who must follow the same benefits or greater than as Original Medicare; these plans are also referred to as “Part C” or “MA” plans.
Depending on the state and county you resided in you may be eligible to enroll in a carrier plan that will provide benefits equal to and in most cases greater than original Medicare parts A and B (and not enrolled in a separate Medicare prescription drug or Medigap plan). Some of these plans have a monthly premium, but many have a ZERO premium cost to the consumer. Medicare Advantage plans do not replace original Medicare, but the carrier plan becomes the primary payor for services. This is a BIG miss understanding of the plans and Medicare recipients must maintain their A & B premiums to be qualified to enroll in Medicare Advantage plans. These plans to help cover medical expenses, routine doctor visits, and often include coverage for prescription drugs. There are multiple types of Medicare Advantage plans to consider including, PPOs, HMOs, and private fee-for-service plans, (whose networks are typically smaller than Medicare’s national network). Medicare Advantage plan premiums vary based on plan selection and region. One way to reduce costs is to select a zero-premium plan. For example, if you enroll in a plan that has a $0 premium, you will only have to pay your Medicare Part B amount, you will not have any extra costs for Medicare Advantage plan itself. Some zero premium plans include gym memberships, prescription drug coverage, over-the-counter items and additional benefits for vision and hearing.
To can find more information on how to get started! Call me directly at 615.944.5707 or schedule an appointment with a link to my calendar.