Wow! Am I the only one feeling bombarded with Medicare Advantage plans or insurance broker companies on TV offering a ton of sometimes difficult to understand “better than traditional/original Medicare” benefits? To help sort thru the flood of information, let’s walk through the basics.
The yearly open enrollment period is Oct. 15 to Dec. 7.
During this time, it is important to do the research to make great decisions.
1) Do not wait to do an assessment of traditional/original Medicare vs Medicare Advantage as Dec. 7 is a drop dead date for changes.
2) If you are new to Medicare (turning 65), there are penalties for signing up late.
3) A master list of the following should be done to ensure the most complete analysis is completed:
- List of all drugs – names, dosages
- List of hospitals
- List of health care providers
- List of DME or oxygen company being used
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4) Part D/Prescription Drug Benefit: Set up your own Medicare.gov account. This will allow for the comparison of historical drugs used with a potential new drug plan. It is important to note that drugs can fall into different levels of coverage/tiers with different drugs, different tiers and different coverage packages for different plans. Each Part D plan has its own coverage limits with differing patient out-of-pocket amounts.
5) Medicare Advantage/MA plans sold are per county and are usually insurance companies. Therefore, what is seen on TV may not be offered in your county. Benefit packages, as seen on TV: “zero monthly premiums, dental, glasses, health club membership and home delivered meals” may not be sold nationwide. Some combination can be sold, but are MA plan specific. Medicare Advantage is Part C Medicare that includes both Part A, C and optional Drug benefit/Part D. Part B’s monthly premium is still separate from any MA plan you purchase.
6) A listing of Medicare Advantage plans in your area can be found under Medicare.gov as well as the “Medicare & You 2022-US Government Medicare Handbook.” This handbook also includes an outline of all Medicare benefits. (Medicare.gov to download the handbook electronically or to order hardcopy booklets.)
7) After doing a quick review of number 3, now let’s do a review of the MA plans in your county. Assess: a) monthly premiums, b) is Part D/Drug coverage included? c) yearly health deductible, d) yearly drug deductible, e) in-network maximum out-of-pocket and f) are your providers included? Each MA plan will be different.
8) Now take a look at original/traditional Medicare. Original/traditional Medicare includes Part A/in-hospital inpatient care and skilled nursing home stays (usually no monthly premium as it is based on quarters worked) and Part B/outpatient hospital, physicians/healthcare providers, DME and oxygen companies. Part B premiums are income based monthly premiums with yearly revisions. Average $148.50 for 2021. (Note: There is an Income Related Monthly Adjustment Amount/IRMAA that increases the Part B and Part D monthly premium due based on individual incomes.) Part D/prescription drug package is sold separately with premiums approximately $35 monthly. Using number 3 will provide similar guidance in selecting a Part D plan. Another great source is SHIBA — Senior Health Insurance Benefit Advisors — funded by Medicare-that is available at 800-247-4422.
9) Prior to seeing any health care provider, it is important to ask: Do they accept traditional/original Medicare? Do they accept your specific Medicare Advantage plan? Ask every time as Medicare Advantage plans will likely require prior-authorization for any care. Every provider can elect to participate with traditional/original Medicare. Every provider can decide to contract with any or all MA plans in the area.
Final thoughts: Identify a trusted insurance agent who has extensive knowledge of Medicare Advantage to help navigate thru the MA plans. Agents are paid by the insurance company — the same amount regardless of the MA plan that is selected. There is no charge to the Medicare patient. Be prepared to complete a work paper that includes your prescription drug list, your preferred provider list, and compare against a review of MA plans in-network for local or regional services. Out-of-network penalties exist for non-emergent care with MA plans. Original/Traditional is nation-wide with no out-of-network penalties.
Try not to get overwhelmed. Take it step by step by step. Have fun!
In Part 2 we will walk through more hints in decision making: Stay with Traditional Medicare with or without a Medicare Supplemental plan, move to a new Medicare Advantage Plan, stay with your 2020 Medicare Advantage, or move back to Traditional Medicare from a MA plan. Lots of choices…
UPDATE: The “Medicare 101, Social Security Benefits and Assistance for Senior Boot Camp” has been delayed. Unfortunately, due to the continued impact to the health care providers from COVID-19, the low vaccination rate, and the state-wide crisis of care standards in effect, we will be rescheduling the community outreach. We will monitor and look to reschedule when it is safer to do an indoor event.
Day Egusquiza is the president and founder of the Patient Financial Navigator Foundation Inc. — an Idaho-based family foundation. For more information, call 208-423-9036 or go to pfnfinc.com. Do you have a topic for Health Care Buzz? Please share at firstname.lastname@example.org.