Changing Medicare Coverage



5 Reasons to Be Cautious When you Change your Medicare Coverage

  1. Never assume your physicians and hospitals are the Medicare Advantage network of participating providers for the new year just because they have been in previous years. Provider networks and Medicare Advantage plans renegotiate contracts yearly.  If you use an out of network provider and have a Medicare Advantage HMO, you will be responsible for 100% of the cost.
  2. Don’t let your Prescription Drug plan “roll over” for the next year without verifying that your prescriptions are still covered, and at a competitive copay. Medicare “Part D” drug plans, and prescription drug coverage as part of a Medicare Advantage Plan “Part C” change copays, premiums and covered medications within their formularies on an annual basis.
  3. Drug coverage should be re-evaluated every year.
    Switching from a Medicare Supplement to a Medicare Advantage plan can end up costing thousands of dollars more if you get sick. Look beyond the monthly premiums and office visit copays for Medicare Advantage plans, and find out what the Annual Out of Pocket Maximums are for each plan.
  4. Don’t assume that Medicare Advantage PPO and POS plans offer the same flexibility as a Medicare Supplement Plan. They don’t. Although these plans offer the ability to use out of network providers, and the Advantage company must approve your some of your medical services. Medicare Supplements do not need need an approval from the insurance company to provide services, and care is still determined solely between you, your doctor and Medicare.
  5. Changing from Medicare Advantage PPO or POS plan to an HMO with the same company to lower your premiums and copays, doesn’t mean the same doctors and hospitals are in the plan.  More companies are eliminating plans with out of network benefits forcing members to change plans either within the same company, or to another.  Different types of plans offered by the same company have different doctors and hospitals in the network.  Again, if you have an HMO and get services from a non-network provider, you are responsible for the entire bill.

How Changing Your Medicare Coverage Effects The Way Your Doctor is Paid

Medicare Supplements

Medicare Supplments (Medigap) pick up what Medicare does not cover like the 20% of Part B Services and the Medicare Part A hospital deductible of $1,288 per benefit period. In other words Medicare still pays their portion and the Supplement pays the difference based on the plan design you choose.

There are 11  different Medicare Supplement plan design that are standardized by the government.  So if you are comparing one company to another, the plan benefits will be identical from no matter which company you are considering.  This method ADDS to your Medicare Part A and B.  You should also purchase a Medicare Part D plan to help with prescription drug costs.

You pay the Medicare supplement premiums directly to the company.  If the doctor want you to have a covered Medicare service, you get that service and then Medicare determines how much your supplement is responsible to pay and how much you have to pay if anything at all.  The big point I’m trying to make here is that because you are just adding to Medicare, it’s still you, your doctor and Medicare that will determine the services and care you can get.  The insurance company does nothing else but pick up the amount that Medicare instructs them to pay.

Medicare Advantage

Medicare Advantage plans do not pick up what Medicare does not cover in full 100%.  It doesn’t fill in the gaps.  Instead it replaces coverage and takes over to manage all of your healthcare.   You will still maintain your Medicare,  but it is used in a different way. When you join a Medicare Advantage plan, Medicare will pay the company that you have chosen a fixed amount each month to provide your medical care.

Both Medicare Supplements, sometimes referred to as Medigap Plans, and Medicare Advantage (MA) plans require that you have Medicare Parts A and B.  If you have earned enough quarters through Social Security either from your own income or a spouse, Part A (Hospital coverage) will be awarded to you automatically and will cost you nothing. Part B (Medical coverage) will be available for you to enroll and the cost will depend on the amount of your income. People with incomes over a certain limit will pay more for Part B.

If you are looking for more than what Medicare alone provides, there are different things you can do. First of all Medicare A and B alone does not give you any drug coverage. If all you want are prescription copays and coinsurance instead of being responsible for the entire cost of a drug, then all you need to do is add Medicare Part D (drug coverage).

Medicare contracts with private companies to provide the Medicare Part D.  Different companies offer different premiums, copays and drugs that are covered.  If this is all you do, you are still leaving yourself exposed to thousands of dollars that you will be responsible for including 20% of all Part B services with no annual cap, and daily expenses while in a hospital or nursing home.

If you want to protect yourself against those expenses, then you can add a Medicare Supplement (Medigap),  OR put your Medicare card in the back of your wallet and join a Medicare Advantage Plan to help cover out of pocket Medicare expenses.  You can’t double dip so you have to chose one method or the other. Fill out the Customized Quote form and we’ll help you choose which type of plan is the “Best” for you.

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