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Medicare Products for Seniors
Understand Your Medicare Options
Congratulations, Colorado Senior, you’ve almost reached the milestone age of 65!
Many things are changing for you, not the least of which is a change in your health insurance as you go on Medicare. Many people are filled with worry, questions and confusion.
"Is Medicare any good?"
"What is the best supplement insurance for Medicare?" "What about drug coverage?"
"Will pre-existing conditions be covered?"
"How much will all this cost me?"
Well, we've got good news for you!
You have many choices, and they are good—really good! It's just a matter of figuring out which is the best supplement insurance for Medicare for you. Just keep in mind that there are strict open enrollment deadlines that must be observed. Some occur yearly, while others occur only once in a lifetime.
Contact us about two to three months prior to age 65 and we’ll be happy to give you a free, no pressure, no obligation consultation. You’ll walk away better educated, and feeling like you truly UNDERSTAND your Medicare options!
Medicare Supplement (aka Medigap)
Original Medicare coupled with a Medicare Supplement is considered the "gold standard" when it comes to your health coverage. Medicare Supplement policies are standardized, meaning all insurance carriers offer the same benefits. The only difference will be the price and service of the insurance company.
Plans are named with a letter and go from A to N. Although there are several good options, the most popular and best Medigap policy by a long shot is called "Plan F". Plan F covers 100% of Medicare deductibles, coinsurances, and excess charges, meaning you have zero out of pocket costs on all Medicare eligible expenses. We call it the “peace of mind plan.”
Plan F even pays up to $50,000 for emergencies if you travel outside of the USA, which is important since Medicare does not cover you outside of the United States.
Medicare Supplement Plans Comparison Chart:
Cost: Premiums for Plan F will depend on your gender, where you live and what company is selected. For example, a 65-year old female living in Fort Collins will pay anywhere from $125 to $140 per month for the most popular companies, while a similarly aged male will pay between $130 to $160 per month.
Positives of a Medigap Policy:
Portable: You can see any doctor that participates with Medicare, anywhere in the U.S.
No Network Worries: No worries about being “in” or “out” of network! This is especially important for those who do a lot of traveling or do not have a permanent place of residence. Medigap policies are especially well suited for “snow-birds,” those who do a lot of RV travel, or live in rural areas.
Best coverage: Plan F provides the very best coverage available so they don't have to worry about paying for any deductibles, copays or coinsurances.
Negatives of a Medigap policy:
Higher price tag: None, other than the higher price tag, so long as you pick one of the comprehensive Medigap policies, such as plan F or G. Click here to view a 132-page booklet published by Medicare called "Medicare and You".
Companies: We offer the best supplement insurance for Medicare from the most popular and lowest priced carriers including Anthem Blue Cross/Blue Shield, AARP United Healthcare, CIGNA, Mutual of Omaha, and Central States Indemnity.
Note: The big item that is not covered either by Medicare or by any Medigap policy are prescription drugs. (See below for a discussion of Medicare Part D Drug plans.)
Remember, these are complex decisions that you’ll have to live with for quite a while.
While we can provide some information here, we are happy to speak to you about your options in a no-obligation phone call.
Get the best supplemental insurance for Medicare for your situation. Only with the information you need to make an educated decision will you feel the piece of mind that these plans are supposed to offer!
Call us today at 970-224-5500 or toll free at 800-553-1444 for a free, no-obligation consultation.
Note: We can also help if you are under 65 and on Medicare due to a disability. You will have a one time open enrollment for a Medicare Supplement when you first qualify for Medicare due to disability, so be sure to call us to discuss your options before the open enrollment period ends.
Medicare Advantage Plans
Medicare Advantage Plans are a relatively new health plan option that falls under Part C of the Medicare legislation.
Basically, a Medicare Advantage plan takes over for Medicare and is sold by private insurance companies following Medicare’s guidelines. If you join a Medicare Advantage plan, you do not forfeit your Medicare enrollment, but you generally get all of your Medicare-covered health care through the Advantage plan—not through Medicare. This coverage usually, but not always, includes prescription drug coverage.
Network: Medicare Advantage Plans are primarily managed care plans—meaning they are either a PPO or HMO which have provider networks that you must be mindful of.
PPOs: You get the best benefits when you go to a network provider. If you go to a non-network provider, you’ll still be covered, but will incur higher out-of-pocket expenses.
HMOs: HMO networks are, usually, smaller than PPO networks. Also, in most cases you have to get a referral from your primary doctor to see a specialist. And also in most cases medical expenses outside the network are not covered except in an emergency.
• You must have both Medicare Part A and Part B.
• You must pay your monthly Medicare Part B premium to Medicare
• You must not have End-Stage Renal Disease
Positives of a Medicare Advantage
Lower price tag: Low premiums are the biggest attraction. Premiums in Northern Colorado can range from about $79 per month for a PPO plan to as low as $0 for an HMO plan. Yep, zero as in zip, zilch, nada.
Changes: How long such $0 premium plans will last is a big question mark, but at least in 2017 they are available from several carriers. Most plans automatically include prescription drugs at no additional cost. Some plans include dental and vision, and even free health club memberships.
Negatives of a Medicare Advantage
Out of Pocket Costs: You will incur costs for virtually every single doctor visit and medical procedure, both in and out of the hospital (except for preventive services which are free). Your costs can include deductibles, copayments and coinsurances which will continue until you reach your maximum out of pocket (MOOP) which could be as high as $6700.
Network Restrictions: The biggest drawback is the requirement to see network providers. What if you want to see a highly regarded specialist that is not in the network? In a PPO you would face higher out of pocket costs, while in an HMO you would generally receive nothing from the insurance if you saw an out of network provider (except in the case of a sudden emergency).
Medigap Plan F vs. Medicare Advantage Summary Comparison
Medicare Supplement (aka “Medigap”) PLAN F
Sample: 65-year old female in Fort Collins will pay anywhere from $127 to $160 per month in 2015.
Anywhere from $0 premium to $79 per month in Fort Collins.
Out of pocket cost to you on Medicare eligible expenses.
Nothing. All Medicare eligible expenses are paid at 100% so you incur no out of pocket costs.
You’ll incur costs for virtually all procedures other than preventive care. In a bad year you could spend up to $6700 in out of pocket costs on some plans, while others may have a slightly lower out of pocket maximum.
Doctor & provider network required?
No. You are free to see any doctor anywhere in the country so long as they participate with Medicare, which virtually all doctors do.
Yes. You must see in-network doctors, otherwise you’ll pay more out of pocket or the service may not be covered at all.
When can you enroll on a guaranteed basis?
You have a six month open enrollment period when you first enroll in Medicare during which you can enroll in any Medigap policy sold in your state, even if you have health problems. This is a once in a lifetime open enrollment. Miss this and you will need to prove your good health to qualify later.
You have an open enrollment period when you first sign up for Medicare as well as every year from October 15 to December 7th.
Do plan benefits always stay the same?
Yes. Plan benefits will not change once the policy is in force.
No. The plan design can, and usually does, change yearly.
What happens if you move to another state?
Policy will not change.
Policy will usually be terminated and you will have to enroll in whatever plans may be available in your new residence area. If you move to a sparsely populated area, you might find there are no plans offered there.
Extra add-on features
Usually none, although a few plans offer free health club memberships.
Most plans include prescription drug coverage. Some may also include dental, vision and free health club memberships.
Stable for existing policyholders who already have bought plan F. Some in Congress want to do away with NEW sales of Plan F arguing that it drives up Medicare costs because it gives seniors no incentive to avoid medical care because it pays too well.
This has been a political football. The Affordable Care Act, commonly known as Obamacare, has cut funding to this program. Funding cuts are slated to start in 2014 and continue for 10 years.
Bottom line of why to buy
a. if you want peace of mind knowing that all of your Medicare eligible expenses will be covered at 100%.
b. You want total freedom to see any Medicare participating doctor.
a. you want the lowest premium possible.
Part D Prescription Drug Plans
Q: What is Medicare prescription drug coverage?
A: Part D of the Medicare Legislation–often called a PDP Plan.
Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have high ongoing drug costs, as well as protection from unexpected prescription drug bills in the future.
Q: How does Medicare prescription drug coverage work?
A: A PDP Plan goes through several stages of coverage:
• A Deductible (optional)
• The Initial Coverage Period (with Tiers and Copays)
• The Coverage Gap aka “The Donut Hole” (with discounts)
• Catastrophic Coverage
Q: How much does a Part D drug plan cost?
A: Costs in Northern Colorado start at $15 per month and go up from there.
In addition to the monthly premium, the yearly deductible is either $0 or $320 for 2015, depending on the plan you have selected. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance.
Q: Which plan should I buy?
A: The best plan for you will depend on your needs and which prescription drugs you take.
There are two ways to get Medicare prescription drug coverage:
1. You can join a stand-alone Medicare prescription drug plan, or
2. You can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.
Whatever plan you choose, Medicare drug coverage will help by covering brand name and generic drugs at pharmacies that are convenient for you.
Q. "Can I Switch Plans Once I Make a Decision?"
A. Sometimes you can, sometimes you can't.
The rules are complicated, so call us with any questions that are specific to your situation.
If you have limited income and your drug expenses are especially high and you are in danger of going into the coverage gap (also know as the "donut hole"), click here to see if you can qualify for extra help with Rx expenses.
We hope this information has been helpful. We’d love to help you further in finding the perfect supplement to Medicare insurance.
Give us a call at 970-224-5500 or toll-free at 800-553-1444 for more information.