Many of you have seen Medicare related commercials lately. The ones I have been hearing about from clients are those that say something to the effect of “Call and see if you qualify for extra services, like $144 back each month” or You could also qualify for a $0 premium plan with extra benefits like dental, vision, gym membership”.
So, before you dash off and call their 800# or go to their website, I thought I would explain what these types of offers are. This time of year, for medicare beneficieries between October 15 and December 7 is known as the Annual Enrollment Period (AEP). This is the time that you notice a ton of mail/email/TV commercials all geared towards getting you to to consider the options available to you. Not so bad, right? If that was all they were doing, then people would not be so confused.
Well, here is a little clarity. As my clients already know, when it comes to Medicare health insurance, you’ve a couple basic options.
- Use your medicare card, to see any doctor in the country that accepts Medicare, and agrees to see you.
- This option addresses Medicare Parts A&B which are coverages for such things as Medicare covered Hospital stay or Skilled Nursing Facility costs (Part A) and doctor and out-patient services (Part B)
- You would need to understand that this leaves you deductibles and copays/co-insurance for Medicare covered charges. These are often offset by adding a Medi-Gap or Medicare Supplement plan (such as Plans F, G, N etc…)
- This options would also not address coverage for your various Prescription drugs. For this, you would want to consider adding a Medicare Part D plan.
OR
- Enroll in in Medicare Advantage plan (also known as Part C)
- These plans address your Hospital stays (Part A) and docotor and outpatient services (Part B)
- These plans may also include coverage for Prescription Drugs (Part D)
- They also may include additional benefits like vision, hearing, gym membership (sound familiar yet?). They may also include coverage for transportation to and from certain doctor visits, or coverage for over the counter items. The list has grown over the years of the added benefits that these plans can include. Some plans even help you with your Medicare Part B (there’s that $144)
- Depending on the area you live, some plans can have as low as $0 premium (yep, just like they say in the commercials).
- AND, if you have Medicaid (Medi-Cal here in California) then, depending on the level of Medicaid you are getting, you could qualify for additional options.
- These Medicare Advantage plans are commonly HMO network based, while others are PPO. That too depends on the area you live in. Each plan will explain the various deductibles and copays/co-insurance you should expect to be responsible for. But the key questions will be “Is my doctor covered?” and “What are the copays for my mediactions?”
OH! So you mean, if I want all the “free stuff” they are talking about, then I would have to enroll in a Medicare Advantage plan?
Answer: Yes. If it is appropriate, and as long as you understand the facts. It makes sense to talk about the options, but know what the costs are, and what impact it has on future options. I’m happy to help, should you want to know the options in California, or our western states here (Wash, OR, Ariz, Texas and a few others).