Medicare Choices

This is a short introduction to your Medicare choices.

And when it comes to Medicare, you do have some choices to make.  But first, let’s take a look at how Medicare works.

Part A of Medicare is hospital insurance.

It has a deductible. It has no premium. Part A covers hospitalizations, home healthcare, skilled nursing facility charges, and hospice.

Part B of Medicare is medical insurance.

It has a monthly premium. And some people pay a higher premium if their income is over $85,000 per year.  Part B has a deductible.

Part B pays 80 per cent of:

  • Doctor bills
  • Ambulance charges
  • Emergency room charges
  • Chemo and radiation costs
  • And most non-hospital medical services

YOU PAY 20% OF THESE BILLS AND THERE IS NO CAP TO YOUR 20%……..which can result in large and never-ending medical bills.

Avoiding financial disaster due to medical bills is why your Medicare choices are so important.  Deductibles and the 20% co-insurance are GAPS IN MEDICARE and some people fill these gaps with a MEDICARE SUPPLEMENT.  Medicare supplements are also known as MEDIGAP PLANS.

Medicare supplements don’t have fancy names – they have letters.

Plans C and G are popular because they fill most – but not all of the gaps in Medicare.

Plans K L M and N have lower premiums because they fill fewer of the gaps and leave you with more bills to pay.

Plan F fills every gap in Medicare.  I tell my clients….”THINK  F  AS IN FULL COVERAGE”.  Because Plan F fills every gap, it has the highest premium.

If you have Medicare and a Medigap plan, you should add a Part D drug plan.

You don’t absolutely have to enroll in Part D but…. if you don’t enroll in a Part D plan when you are first eligible, you will pay a late enrollment penalty if you enroll several years down the road. So… what does this type of coverage cost?

There’s the Medicare Part B premium, which is $134 per month.

Then there’s your Medicare supplement cost which depends on the letter PLAN you choose. A 65-year old can get Plan F in Arizona

for $145 in 2018.

And then there is the cost of a Part D drug plan.  If you take only generics, a lower-cost plan should work for you. But if you take one or more brand drugs, you’ll get lower overall cost by getting a higher premium plan.  There are over 20 Part D plans available in Arizona -which makes choosing a Part D plan confusing – and I’ve come across quite a few people who are paying waaaay too much for their Part D plan.

Now, let’s talk about Medicare Advantage

Medicare Advantage plans look a lot like a really good employer health insurance plan and are offered by insurance companies which have a contract with Medicare.  If you enroll into a Medicare Advantage plan, you are choosing to get your Medicare benefits through that insurance company.

  • Most Medicare Advantage plans in Arizona have no premium.
  • Almost all Advantage plans include Part D drug coverage.
  • Almost all Arizona Advantage plans offer a free gym membership.
  • And some (but not many) offer some dental benefits like cleaning and x-rays.

Most Arizona Advantage plans are HMOs and that means they have networks of doctors, hospitals, labs, etc.  And you can only use providers who are in the network and contracted with your Advantage plan.

Referrals are required to see a specialist  – and tests like CT scans need prior authorization from your plan.

There are a few PPO plans in Arizona.  PPO plans allow you go out of the network but PREFER you stay in-network.

PPO plans in Arizona have significant premiums.  Referrals are not required with  PPO.

All Medicare Advantage plans have co-pays or co-insurance for medical services you receive such as

  • Doctor visits
  • Labs
  • Hospital admittance
  • Physical therapy
  • chemo and radiation for cancer treatment

If you are considering enrolling in a Medicare Advantage plan, you need to ask some questions.

Are your doctors in the plan network?

How are your prescriptions covered ?  And at what cost? One plan might have a $45 co-pay for a brand drug you take…while another plan’s co-pay for that same drug might be $90.

Each Advantage plan as a maximum out of pocket which protects you from large and never-ending bills.   In Arizona, MOOPs range from $2,800 to $6,700.

Your Medicare choices summarized:

You have two ways to get your Medicare coverage.  One way is to use your Medicare card and buy a Medicare supplement and a Part D plan.  I call this the PAY IN ADVANCE SYSTEM because you pay monthly premiums and then have no co-pays – – – or limited co-pays for your Medical bills.

I call Medicare Advantage the PAY AS YOU GO system because you have no monthly premium. But…. you have co-pays when you go to the doctor, or if you get physical therapy, or diagnostic tests, or if you end up in the hospital.

Medicare choices are confusing.

I’m sure you have lots of questions about your Medicare choices and I can answer them for you. I have over ten years of experience helping people understand Medicare and their Medicare choices.

Call me or email me and I’d be happy to answer any questions you have —- and I can help you get a Medicare supplement and a Part D plan …… or a Medicare Advantage plan – whichever type of coverage you think works best for you.

Here are links to other topics I’ve written about:

Considering Medicare Advantage

Part D and Preferred Pharmacies

Medigap Plans for People Under 65


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