Unbeknownst to many, there are several Medicare plans to choose from. In our case, after much research and finally speaking with someone far more knowledgeable than us, we came to find that Medicare Plan F, although more expensive, was indeed the far better choice. Why, one might ask? It is simple, my spouse was diagnosed with numerous, independent catastrophic illnesses which, of course, meant many doctors, countless surgeries and treatments and so on. So, though the premium was higher, Plan F afforded us the ability to receive all the medical care and medication that so urgently required.
Kindly note, before proceeding, today’s Blog will be one of the most lengthy I am likely to share; however, Medicare can be complicated, confusing and, if one does not choose the right plan, such a mistake can be quite costly both financially and without the full needed coverage could also result in earlier demise. One other important note, when first signing up for an additional Medicare Plan, it is illegal for insurance companies to inquire about prior or current medical conditions. Therefore, for one’s own sake, do not offer information that is not required. When I was in the process of comparing companies, there was one Agent who dared ask about my spouse’s health. In an instance like this, one cannot afford to be shy or intimidated. My response was simple, “It’s my understanding that we do not have to answer any medical questions.”
Most individuals going on Medicare learn quickly about Part A and Part B, both of which are generally offered by a private insurance company which contracts with Medicare.
Next, there is Medicare Prescription Drug Plan, called Part D. The best way to select the most appropriate Medicare Prescription Drug Plan is to have a full list of medications available as the rate and what medications are covered differs by company. Though not a computer whiz by any means, I found it easiest to visit the Medicare site and input each of the medications.
In addition to these original plans, one generally has the option to sign up for either a Medicare Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS) or Medicare Medical Savings Account (MSA). This is assuming the individual meets the following criteria: 1) Patient lives in the service area of the plan he/she wishes to join. The plan can provide specific information regarding service area. In addition, if the patient lives in a different state for part of the year, one must ensure the plan will provide coverage in both states. 2) Patient must already subscribe to Part A and Part B. 3) Patient does not have End Stage Renal Disease (ESRD).
Medicare Medical Savings Account (MSA) Plans are akin to Health Savings Account Plans which are available outside of Medicare through which one has the flexibility of choosing his/her health care providers and services. MSA Plans consist of two parts which combine a high-deductible insurance along with an account set-up specifically for health care costs. 1) High-deductible health plan – Part C will only begin to cover medical costs once the individual meets a high yearly deductible and this does vary by plan. 2) The second part of MSA is, as stated, an account set-up specifically for health care costs prior to meeting one’s deductible. Assuming one is in good health and is not under one or more physician’s care for serious illnesses, this might be seen as the preferred option.
Medicare Supplement Insurance (Medigap) is sold by private insurance companies and can assist in paying some costs not covered by Original Medical (i.e. deductibles, copayments, coinsurance, medical care when traveling outside the U.S.A.).
Important things to know about Medigap:
· One must be enrolled in Medicare Part A and Part B.
· If you belong to a Medicare Advantage Plan you may apply for Medigap; however, ensure that the Medicare Advantage Plan is discontinued prior to Medigap policy begins.
· Patient pays monthly premiums to both the private insurance company for Medigap and Medicare for Part B plan.
· A Medigap policy covers only one (1) individual, not a couple.
· A Medigap policy may be purchased from a licensed insurance company in patient’s state.
· A Medigap policy is guaranteed to be renewed even if one’s health declines as long as the patient pays the premium.
· Any Medigap policy sold after 01 January 2006 is not allowed to include prescription drug coverage.
· Lastly, be aware that it is illegal for any company to sell a Medigap policy if one has a MSA.
For forms, help and other resources, please visit:
You can find the following topics:
· Health & Drug Plans
· Find & compare doctors, hospital & other providers
· Get help paying costs
· Find suppliers of medical equipment & supplies
· Get Medicare forms
· Medicare & You
· Mail you get about Medicare
· Lost/incorrect Medicare card
· Report fraud & abuse
· How do I file a complaint (also called a “grievance”)?
· Identify theft: protect yourself
· Phone numbers & websites
· Notice of Privacy Practices for Original Medicare
· Contact Medicare
· Medicare Frequently Asked Questions
For those who would like to share their own experiences, advice which might be of help to others, questions or ideas for this Blog please feel welcome and encouraged to do so by commenting below.
Just recently in talking with a friend about his mother’s Medicare coverage, I came to realize that far too many individuals are woefully uninformed about their Medicare options which can lead to catastrophic financial results if an elder 1) is not familiar with the vast array of plans there are to choose from and 2) has not selected a plan which meets their specific medical needs.
In our situation, before my spouse became ill, we too were uninformed to say the least. I spent hours and ended up wasting at least two reams of paper printing out documentation, explanations, etc. Even calling a Medicare office directly did not provide me with all options available. Fortunately, we met a gentleman who was well versed in the area which enabled us to select the best plan and as a result saved us at least tens of thousands of dollars in medical expenses if not more.