Medicare Explained – Part II
People nearing age 65 often find themselves bombarded with mailings and solicitations for Medicare and it can quickly become an overwhelming decision. Figuring out what is in your best interest can be a difficult decision, especially since those providing the information stand to profit from selling you a plan.
Providing an unbiased education on the topic was the motivation behind our Medicare Explained videos. This video is designed to give you an education on the various aspects of Medicare without the solicitation so you can become a more informed consumer.
Excellent. I learned a few things. After 4 years on original Medicare and a supplement, I am going to consult with an independent agent whom I trust. I shared this video and hope people do their homework. Not all things remain the same with our health. Thanks to you and the team.
The lady mentioned signing up online through Social Security but it is actually the medicare.gov website. You can also compare prescription plans (part D) or Advantage plans (part C) at https://www.medicare.gov/plan-compare You enter your zip code and it will show you what plans are available in your area (usually by County), so you are not going to be wading through hundreds of options.
To expand on a couple of things, Advantage Plans (part C) actually combine parts A, B and D, so there is no need to purchase a separate prescription plan and incur its cost. You will still pay the Part B cost, some plans have an additional premium (usually those are PPO plans ie you can see any doctor, not limited to a network, similar to regular Medicare), many (like mine) have no additional premium, and some give you a portion of your premium back (you may hear that on tv commercials), those are usually the ones you are paying an additional premium for. However, if you are very low income, you may get some or all of your premium paid for by either SS or your State (for both Advantage as well as regular Medicare plans). Advantage plans may also offer additional benefits like dental, vision, hearing, fitness (Silver Sneakers aka a free gym membership, limited to participating gyms) for no additional fees. My co-pays are low….$0 for my PCP, labs, xrays and other imaging like MRIs (you may need a Prior Authorization), and $25 for a specialist such as a Rhuematologist, Cardiologist, Physical Therapist etc. I do have co-pay on medications, however, if you are low income you can apply for and receive Extra Help which lowers those costs (many of my meds are free, the most I ever pay is $8.65). On the meds, there is no “donut hole” like the traditional Part D. Along with a variation of premiums, some Advantage plans have deductibles, and some don’t.
My plan is an HMO so I have to stay in-network for physicians, and I need a referral from my PCP to see a specialist, but I have never had a problem finding a good doctor or getting a referral. I have to stay with a participating pharmacy but they include the biggies like CVS, Walgreens etc.
I knew going into Medicare that I had complex chronic illnesses that may get expensive with labs and testing so I opted for an Advantage Plan. Mostly because I was not yet 65, but rather on SS Disability, so using regular Medicare would subject me to those deductibles, 20% co-pay (on top of your deductible!) and donut hole) as well as the cost to purchase one of those Medigap/Supplement plans was an exorbitant cost.
As she mentioned, Advantage plans are private companies. Names you are familiar with like Aetna, Cigna, United etc. I have a very expensive illness that is covered 100% by my plan (the medicine alone is $4000/month), and my probable upcoming surgery for another matter is going to be covered at 100%.
Lastly, and I am on an Advantage plan so this may not be the same for regular Part D, but even if your medication is not on the “list”, called a Formulary, you will still receive a one-time 30-day supply and your doctor can appeal the denial for medical necessity. Some of the more expensive meds (tier 3-4) meds may require you to try a less expensive option first, I had to do that with my migraine med, but all I had to do was exhaust their list or have my doctor say I had already tried them (prior to coverage) and they didn’t work or I was allergic) and my expensive one was covered.
I have been on an Advantage plan for going on 8 years and love it. In those 8 years, twice my plan was no longer going to be available the next year, so I had an option of changing plans (including to regular Medicare) without the health questionnaire she mentioned. I was able to choose a comparable plan with my same company (Aetna).
BTW, I have a friend with regular Medicare and she recently had some major health issues and the 20% has left her with some major bills. She has no Medigap, she is under 65 and on Disability like me, I have been begging her to change to an Advantage plan for years, knowing anything could happen, and she now sees why she should have.