WHAT IS MEDICARE?

Medicare is health insurance for:

•        People 65 or older.

•        People under 65 with certain disabilities

•        People of any age with End-Stage Renal Disease (ESRD) (permanent kidney

         failure requiring dialysis or a kidney transplant)

WHEN CAN I APPLY FOR MEDICARE?

Most people enroll during the 3 months before the month they turn 65.

When you get close to qualifying for Medicare, you will get bombarded with information that can make you feel like it is impossible to know the right choice.

The PROS & CONS section below will help.

Knowing all of your options gives you the certainty to choose the best solution for you.  

Perhaps the most important thing to know is that Medicare does NOT cover everything 100% and there are 2 ways to protect yourself from the costs Medicare doesn't cover.

Each of the 2 ways has its pros and cons and not all plans are available in all counties. This is where a conversation with an agent can help.

MEDICARE SUPPLEMENT PROS & CONS

Pros: 

CONTINUITY AND STABILITY--standard Medigap policies are guaranteed renewable even if you have health problems.  This means the insurance company can't cancel your Medigap policy as long as you pay the premium. 

PREDICTABLE MONTHLY EXPENSE--depending on the plan chosen, you will not have to pay any deductibles, coinsurance or copays.

FREEDOM OF DOCTOR CHOICE--you can be treated by any doctor or hospital that accepts Medicare patients.  In other words, you are not limited by having to choose a doctor or hospital from a contracted network of providers like you would have to do with a Medicare Advantage Plan.  Also, you do NOT need a referral to see a specialist--just make the appointment and go. 



Cons:

You will have a premium to pay for the coverage.  Prescription drugs are not included so you will need to purchase a separate Prescription Drug Plan (PDP).

ADVANTAGE PLAN PROS & CONS

Pros: 

INCLUDES PRESCRIPTION DRUGS--plans referred to as MAPD will include prescription drug coverage so you would not have to have separate Rx coverage.

$0.00 OR LOW MONTHLY PREMIUM--in some counties, companies may offer plans with no monthly premium.

EXTRA COVERAGE--for an additional premium, some plans may offer health club membership, extra dental, vision, hearing, chiropractic and acupuncture coverage.

Cons:

PLAN IS GOOD FOR ONLY 1 YEAR--Medicare Advantage plans are good for 1 calendar year.  Companies, may or may not re-contract with CMS annually.  As a result they may choose to discontinue offering a plan.  They may also keep the plan(s) they offer, but change the premium, co-pays and out of pocket maximums for the plans they offer each year. 

LIMITED PROVIDER CHOICES--except for emergencies, HMO MAPD plans, require you use their contracted network providers, otherwise you will not be covered.

UNCERTAINTY OF PROVIDERS--the plan(s) contracted network providers can change any time.  Even though your doctor might be in the network when you enroll, any time later that may not be the case making you have to choose another doctor.

UNPREDICTABLE EXPENSES--HMO and PPO MA plans require the member to make co-payments up to an annual out of pocket maximum.  For some plans, these costs would be in addition to a monthly premium if the plan charged one. 

DEDUCTIBLES--some plans have a deductible that you must meet before the plan will pay.

There are a number of things to consider when choosing which would be best for you. As a Medicare advisor I can answer your questions and assist you to secure the most suitable Medicare solution for you. 

Contact me to discuss your Medicare needs.