MedicareBob

If you have Original Medicare and a Medicare Supplement, you do not need a referral to see a specialist. You can go to any doctor or any hospital as long as they accept Original Medicare. It’s as easy as calling and making the appointment.

I want to start this post by saying that I do not think Medicare Advantage plans (Medicare Part C) are bad. There are many Medicare Advantage plans out there that are very good plans and it really depends on the person’s situation and their needs on whether or not a Medicare Advantage plan is a good choice for them or not. My goal is not to bash Medicare Advantage plans but to educate. Unfortunately, it is all to common that agents will sell a Medicare Advantage plan to someone without fully giving them all of the information and the full effect of their choice. 

Let’s start by explaining what a Medicare Advantage plan (Medicare Part C) is and how it works. A Medicare Advantage plan is a private alternative to Medicare. Medicare pays these carriers such as Aetna Coventry, Cigna Healthspring, United Healthcare, Humana etc. to provide seniors their benefits more affordably than they can provide them. Medicare then regulates these carriers to ensure that they are doing their job and they are doing it right. 

Medicare takes the premium that you pay them and goes to each specific carrier and they create a “benefit package”. They then meet with doctors and they come up with a “fee structure” that the doctors will agree to accept, this is why most Medicare Advantage plans are HMOs and PPOs. 

These are some of the risks to a Medicare Advantage plan:

· If you want to upgrade to a Medicare Supplement, you have to medically qualify. If you can not qualify, you are stuck with Medicare Advantage plans. 

· You have a network of doctors and hospitals. You have to sign an annual contract with the carrier for coverage but your doctor does not. They can drop that carrier anytime and they do not have to check with you first. 

· Limited to doctors. If you are having heart surgery and the best cardiologist isn’t in your network, your only option is to be stuck with the mediocre doctor or pay more out of pocket for your surgery. 

· Inability to budget your healthcare costs. If you look at the Summary of Benefits, most plans will read: Lab work $0-$300. You have no way of knowing what your costs will be until the time of service. If you are on a fixed income, budgeting is very important. Especially when it comes to your health. 

· Limited drug coverage. If you choose a Medicare Advantage plan you are only able to choose their drug coverage. In most cases, the plans with great drug coverage with have limited or more expensive health benefits and vice versa. Whereas, if you opt for a Medicare Supplement, you get the choice of around 25 different drug plans. 

The only real pros to the Medicare Advantage plans are lower premiums and sometimes carriers will throw in additional benefits such as some dental, vision or hearing. However, they can cancel those benefits at any time because Medicare doesn’t cover those benefits so the carriers are not required to cover them. The cut and dry of Medicare Advantage plans is that you are giving up predictability, flexibility, you have co-pays for most services, you have to get referrals and prior authorizations and possibly the option to upgrade, all for lower premiums. It is so important to research the plans and know all of your options before you make your final choice. None of this information is meant to scare anyone or sway them because as I said, my company sells Medicare Advantage plans. My goal is to educate people on the facts and these are the facts. 

This Rate Watch Wednesday is focused on Medicare Supplement Plan G, for a male and female, ages 65 thru 75 in Brownsville, Texas (zip code 78521). As I have said before, Medicare Supplement plans are all Federally regulated by the government. There is no reason for anyone to pay more for their Medicare Supplement Plan G with one carrier over another because the letter of the plan dictates the coverage, not the carrier. You are not getting any additional benefits by paying more. That’s why it is important to shop your Medicare Supplement coverage every year, and we can help you with that. 

You may ask, “Why do these companies charge different prices if they are all the same?” That’s a great question. Carriers have different administrative costs and they have different profit goals. There’s tons of different reasons why these big companies charge different prices. What you need to know is, just like in your Medicare book, Medicare Supplement Plan G is the same with every carrier. 

As we all know, going to the hospital can be a very pricey visit. If you are hospitalized, your Medicare Part A deductible is $1,364 for 2019. That deductible is a per occurrence deductible so you would normally have to pay that every time you are hospitalized. That deductible doesn’t include any procedures or treatment you have done. This is the cost if you have Medicare ONLY, however with Medicare and the Medicare Supplement Plan G, you would pay nothing. The Medicare Supplement Plan G covers that deductible for you. If you are admitted to the hospital, Medicare has a co-pay starting day 61 and that increases starting day 91. The Medicare Supplement Plan G would cover that for you as well. So, to answer the question, “What would I have to pay with Medicare and a Medicare Supplement Plan G?” you would pay nothing, with Medicare and the Medicare Supplement Plan G your hospital costs are zero.  

How you sign up for Medicare depends primarily on if you’re drawing Social Security. If you are currently drawing Social Security and you’re turning 65, you’ll automatically be enrolled in Medicare Parts A and B. You’ll receive your Medicare red, white and blue card about three months before you turn 65. Starting your birth month, Medicare with deduct $135.50 out of your check. That is Medicare’s Part B premium for most people. 

If you’re not drawing Social Security, there’s three ways you can sign up for Medicare: 

· Go to the Social Security Office and sign up. 

· Call the Social Security office and sign up. 

· You can go online to Medicare.gov and sign up online. 

If you are still working and have coverage through your employer, you will need a form called “Creditable Coverage” form. You will need to have that form filled out by your employer. Once that’s been filled out, you can either mail it to the Social Security office or bring it into the office. Once that’s been turned in, you can apply for Medicare. 

This Rate Watch Wednesday is focused on Medicare Supplement Plan G, for a male and female, ages 65 and 70 in Houston, Texas (zip code 77084). As I have said before, Medicare Supplement plans are all Federally regulated by the government. There is no reason for anyone to pay more for their Medicare Supplement Plan G with one carrier over another because the letter of the plan dictates the coverage, not the carrier. You are not getting any additional benefits by paying more. That’s why it is important to shop your Medicare Supplement coverage every year, and we can help you with that. 

You may ask, “Why do these companies charge different prices if they are all the same?” That’s a great question. Carriers have different administrative costs and they have different profit goals. There’s tons of different reasons why these big companies charge different prices. What you need to know is, just like in your Medicare book, Medicare Supplement Plan G is the same with every carrier. 

The only time you are automatically approved for a Medicare Supplement is when you turn 65 years old or if you delayed your Part B enrollment and started your Part B later on in life. If you are wanting to upgrade from a Medicare Advantage plan to a Medicare Supplement plan or you are wanting to switch your Medicare Supplement plan to another plan to save money, you will be subject to answer heath questions. There are no medical tests or a physical like when you purchase life insurance. How the process works is the agent that assists you with your application will ask you a series of health questions and after the application is submitted, you will most likely be contacted by and underwriter from the carrier. The underwriter will then ask you some of the same health questions and pull your medication report for any red flag medications. After this interview is completed, you will wait for the underwriter to determine whether or not you are approved with their specific carrier. 

Simple fact for anyone that has a Medicare Supplement plan: you can shop your Medicare Supplement plan all year long. The December 7th deadline only apples to anyone that has a Medicare Advantage plan or switching your Part D drug plans. If you are experiencing a rate increase on your plan, you can shop your plan for a better rate. If you have a Plan F, Plan G, Plan N or any Medicare Supplement plan you can shop your plan all year long. There is no reason to pay more with one carrier over another because these plans are all federally regulated. The letter of the plan dictates the coverage, not the carrier. So, give our office a call and we can help you start saving today.