Medicare can be confusing for those about to turn 65. Questions that seniors struggle with: Will my Medicare Plans A and B provide enough coverage? Can I afford to supplement them, to protect myself against additional medical and prescription costs? Which should I choose – Medicare Advantage or Medicare Supplement? How do I find affordable medicare solutions and Medicare insurance brokers near me?
Before a senior starts to compare Medicare advantage plans 2017 coverage and premiums, he or she should understand the basics of Medicare, and its parts. Medicare Part A – free to most U.S. residents age 65 or older – provides hospitalization coverage. The entire cost of each hospital stay of 60 days or less is paid through Part A. Once the stay exceeds 60 days there is a fee in 2017 of at least $329 a day. Part A also covers skilled nursing care, with no charge to the patient for the first 20 days of the stay.
Part B, for which most seniors pay a monthly $134 premium, covers approximately 80 percent of fees for doctor visits, lab work, X-rays and several other medical services and durable equipment. There is an annual $183 deductible for Part B. For seniors who are drawing a monthly social security payment, their Plan B premium is automatically deducted each month from their social security check or bank deposit.
Medicare Parts C and D are optional, and designed to offer seniors additional coverage and/or a reduction in the cost of their deductibles, co-pays and other out-of-pocket expenses for medical, dental and pharmacy costs. Medicare Advantage Plans and Medicare Supplements are the two Part C options. Medicare Part D provides additional prescription coverage.
The most important, and perhaps most difficult choice for seniors is whether to sign up for a Medicare Advantage plan or to choose a Medicare Supplement plan instead. Both have their own advantages. While a Medicare Supplement plan often provides benefits not offered by Medicare Advantage Plans (often referred to as MAs), it is generally more costly. For a senior that travels extensively, however, a Supplement may be the best option, as Medicare Advantage Plans are specific to the state, and provide no coverage beyond state borders. Some Supplement plans even provide emergency coverage when traveling overseas. A snowbird who lives in Minnesota eight months of the year but spends the winter in Arizona would need to choose a Medicare Supplement for any winter coverage beyond Medicare Parts and B, for example. The exception is emergency care.
While many Part C plans offer pharmacy coverage, some don’t. Were a senior to choose a Medicare Advantage Plan or Supplement that provides no prescription coverage, she could then choose a Part D plan as well, with its own premium and deductible.
In general, for budget-conscious seniors who reside full time in one state, Medicare Advantage Plans are the most advantageous. Let’s take a look at a few.
A senior who lives in Portland, Oregon has several carrier choices for his Medicare Advantage Plans, each of which offer more than one plan. One carrier, for example, offers five different MA plans, with a wide variety of 2017 monthly premiums. For those who need to keep their premiums low, and don’t mind the restriction of seeking care from only those in the designated network, this carrier offers three choices, two of which have zero premiums. Its two PPO plans, which allow seniors to use out-of-network providers for an additional fee, the premiums each month are $16 to $116. In the same area, another carrier has one zero-premium HMO plan, and one PPO. For the latter, the monthly premium is $32.
A smart comparison of plans should include a thorough knowledge of the medical needs of the senior or seniors looking for coverage, as well as their budget. As an example, a senior who regularly takes several costly prescription medicines would do well to find a Medicare Advantage plan that includes prescription coverage, rather than choosing a zero-premium plan with no pharmacy coverage simply to avoid a monthly premium. The other option, of course, would be a combination of MA with no pharmacy coverage and a Part D plan, whose combined premiums are competitive.
As a comparison, let’s look at what’s available in Maricopa County, Arizona. Here a national carrier, for example, has PPO Medicare Advantage plan with a zero premium, but no pharmacy coverage. Its in-network co-pay for primary care physician is $15, for specialists $40. Out of network, these costs are covered at 50 percent. Its in-network annual deductible is $599, and its annual out-of-pocket expense (the maximum a senior would pay for the year) is a hefty $6,700. For someone with few or no medical problems and little need for prescription medications, this plan might well be an affordable option.
Another choice might be a national carrier’s medicare advantage plan at $32 a month. This plan, an HMO, charges no co-pay for a visit to a primary care physician, and $15 for a specialist visit. It includes pharmacy coverage and has no annual deductible. The annual out-of-pocket ceiling is $3,200.
For a comprehensive look at the various Medicare enrollment 2017 plan options and the local insurance brokers that can help finalize the choice and activate the chosen plan, a senior should look to the Medicare Coverage Helpline.