Helping You find the Right Plans for Medicare

Between television ads and the non-stop barrage of mail advertising, getting the plan that is right for you is extremely difficult.  Original Medicare is confusing enough.  Choosing supplemental plans can be even more perplexing.  Whether you are newly eligible or looking to change plans, we can guide you through the myriad of plans available. 

            Before you decide which type of plan you want, you need to know the basics of Original Medicare.  What is Original Medicare? 

            Medicare consists of two parts and the monthly premium for Medicare Part B for 2021 is $148.50.

1. Part A (Hospital) – Part A covers Hospital, Skilled Nursing Home, Blood and Hospice Services
2. Part B (Medical) – Part B covers out-patient services such as Doctor, Lab, X-Ray, Home Health Care, etc.

Now that you know what Original Medicare covers, now you can look at the various types of “Gap” or Advantage coverage.

What is a Medicare Supplement or sometimes called a “Medigap” policy?  A Medicare Supplement helps supplement Original Medicare and is sold by private companies.  Original Medicare pays for much, but not all, of the cost for covered health care services and supplies.  These are the “gaps” in Medicare coverage.

            What is a Medicare Advantage plan sometimes called Medicare Part C?  A Medicare Advantage plan is an “all in one” alternative to Original Medicare.  These “bundled” plans include Part A, Part B and usually Part D.

 If you choose to go with Original Medicare and a Medicare Supplement, you’ll also need to enroll in a Prescription Drug plan also called Part D.  The advantages of a Medicare Supplement type plan are:

1. You can see any doctor or hospital that takes Medicare in the United States
2. Depending on the Medicare Supplement, you can choose to see any doctor, whether they take Medicare or not
3. There are no prior authorizations required because Original Medicare covers most types of medical accesses or procedures. The only caveats are:
4. The procedures must be Medically Necessary and
5. Either be Preventive or Diagnostic

Some of the Disadvantages are:

1. You will pay a monthly premium for both the Medicare Supplement and the Prescription Drug Plan. That premium will increase yearly as you get older.

If you choose a Medicare Advantage type plan there are also advantages and disadvantages:

      Some of the advantages are:

1. Usually there is no monthly premium
2. That plan may offer a “give back” clause
3. That plan may offer some dental or vision benefits
4. That plan may offer a transportation benefit

Some of the disadvantages are:

1. You must use the participating providers of that plan
2. You may not be able to see your provider (we will check that for you BEFORE you enroll)
3. Most Advantage plans have copays and deductibles, where the Medicare Supplement does not

Because there are so many types of plans, i.e., Medicare Advantage, Medicare Supplement, etc., it is very difficult to ascertain which plan would work best for you now and in the future.  That’s where we can help you understand what each plan offers.  We can assist you in understanding how each plan would work for you based on your specific needs like physicians and prescriptions.   We listen to You. 

For Example:  what are your priorities? 

1. Are physicians a priority OR
2. No monthly premium a priority?
3. Do you need transportation benefits?
4. Do you want Dental or Vision benefits?

Also, after you enroll in the plan that you choose, we are there to assist you with and questions or even, claims and bills, that you may have.  Lastly, an annual review during Medicare Open Enrollment is always a must.  We love to talk to you about any changes that you’ve had during the past year and if we need to make a change in your insurance coverage.  That is how we can provide “The Right Plan @ The Right Price.”