So if you are within 12 months of turning 65, get ready for the onslaught of mailers and phone calls about Medicare. You will end up getting about 800 pounds of stuff in the mail, agents calling your phone, and friends giving you advice about Medicare that probably should keep quiet. Here are the basics; Medicare has 4 parts, A,B,C and D, that I will get into in a minute. The first question you have to answer is: are you coming off of a PPO plan or an HMO plan?
Medicare is unique in the way it delivers healthcare to its members
The two choices with Medicare is “Original Medicare” with a Supplement (I call it the PPO option), or Medicare Advantage Plan, sometimes called an MAPD which stands for Medicare Advantage Prescription Drug (I call it the HMO option.) The #PPO option allows more freedom for members. There are many more doctors to choose from, most times they can see a Specialist without being referred, and most members feel they are more in control. The #HMO option is more restrictive where you allow the insurance company to “administer” all of your Medicare and you are in a captive system. This is a cheaper model, but with fewer choices, where you can ONLY see providers in that specific group.
The Medicare letters can be confusing too
Part A: Hospital services, covered 100% by Medicare, NO cost to members
Part B: Physician services, covered 80% by Medicare, cost is determined by your annual income
Part C: Medicare “Supplement”, designed to cover much of the 20% of Part B. Part C (called MediGap, Medicare Supplement and other names) is optional for Medicare enrollees. Cost for member is about $150 a month
Part D: Prescription Drug Plan, to help pay for prescriptions. This plan can cost as little as $20 a month, up to $150 a month, depending on your drug needs.
Someone who chooses the Part A,B,C,D above, is in the Original Medicare, and what I call the PPO version of Medicare. The HMO option (as I call it) has all of these parts, but you are allowing the insurance company to handle or “administer” these, in their network or group. Not a bad choice, just very limiting and probably not a good fit for someone on a PPO in a Group Health Plan now.
GOOD ADVICE: Find an agent that you trust and have them get into more detail…this is a fairly big decision
Steve Brauer, Principal, Brauer Insurance Services, www.brauerinsurance.com (877) 421-4325