What are my insurance options when it comes to Medicare?
Who offers the best options for the least amount of money?
Today I am going to start letting people know what companies offer what and basically how much it will cost them to sign up. As you may know, we are now under full swing in open enrollment for Medicare and benefits would start on January 1st of 2010.
Now let’s say you chose a plan, and you go for your annual visit to the doctors in January and for whatever reason you are not happy with that plan that you chose a month or two ago, are you stuck in that plan? No, you are not. You can change your plan under certain conditions if I am not mistaken and Medicare has not changed their rules recently. But keep in mind that you can only change from January 1st to March 31st.
The most common problem that seniors face when it comes time to look over their Medicare benefits is the cost, because let’s face it, to most people the cost of the plan is what irks all of us. So what companies offer what plans and what are their costs.
Most seniors don’t have the time, or the patience to look at a Medicare publication that is 500 pages or more of different plans and try to figure which is best. So the majority of our seniors keep what they have, pay off the rocker prices because they don’t understand the differences in these plans.
As an independent agent I have basically looked at the top companies that offer Medicare plans and picked a few. Some are based on price; some are based on the extras that they offer.
I do give this piece of advice, if you or someone you know takes a lot of medications and they are generic in majority, and then go with a plan that covers the generics in the “coverage gap period” so that you have very little or no out of pocket costs during that period.
If you take a lot of medications and you are on a fixed income, then apply for extra help, each state has program that can help you and the people are friendly and full of information.
If you don’t qualify for extra help with your medications, but you can’t afford them, the drug companies themselves have programs that your doctor’s can apply for you to get medications at a reduced cost.
And don’t forget that a lot of pharmacies like CVS, Wal-Mart, Walgreens, Rite Aid and others have good prices for medications for seniors.
Medicare Supplemental Plans
So let’s look at Medicare Supplemental Plans also known as Medigap Plans, just about every state offers medigap plans. What is a Medigap plan? A medigap plan is basically hospital, medical coverage. The most common Medigap plan sold across the US is plan C. Plan C covers your hospital, your medical and the 20% of medical expenses,
Also before I go any further, when looking at Medicare supplemental plans, always ask if the plan is community based rated or age rated. Why is this important? If a plan is community based rated then everyone in that area is paying the same rate. If the plan is age rated, the older you get the more you pay.
Now to make things a little simpler for the normal or average person there are 12 different Medicare supplemental plans available. If you are under 65 years old and are on Medicare due to disability, keep in mind that your specific state may or may not offer all the plans.
What do the plans cover?
Because the Federal government designed these plans, no matter what company you go with the benefits that these plans offer do not change. I am going to give an overview of what these plans cover one by one. I am going to write about the 5 most sold plans across the boards which are Plan A thru Plan F.
PLAN A – Medicare covers all hospitalization for the first 60 days but you will be responsible for $1068.00 which is your part A hospital deductible.
Plan A will pay days 61 thru 90th at 267.00 a day and Medicare will pay all but $267.00 a day
Hospitalization is a semi private room and board, general nursing and miscellaneous services and supplies.
Plan A also covers skilled nursing facility care, Medicare covers the 1st 20 days, and then you will be responsible for days 21st thru 100th and will have to pay up to 133.50 a day. Plan A does not cover that.
Plan A does cover the first 3 pints of blood, which Medicare does not, but then any additional amounts that you may need, Medicare covers at 100%.
Medicare Part B – Medical Services per calendar year.
Medical expenses- in or out of the hospital and outpatient hospital treatment , such as Physician’s services, impatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.
Plan A does not cover the part b deductible, you are responsible for that. Medicare covers 80% of your medical expenses and plans A covers generally the 20%
Plan A also does not cover the part b excess.
PLAN B –
The only difference that exists between plan A and Plan B, is that Plan B covers the Hospital deductible of $1068.00
PLAN C
PLAN C covers Part A Deductible of $1068.00; it also covers the Part b deductible as well of $135.00 and the 20% of the medical expenses, as well as the 1st 3 pints of blood, skilled nursing facility care, from days 21 thru 100, Medicare covers the first 20 days in a skilled nursing facility. Some of the extras that may be offered with plan C is foreign travel.
Keep in mind that Medicare does not cover foreign travel at all. Some companies offer this as an extra benefit. One company in particular is AARP underwritten by United Healthcare.
The foreign travel benefit works like this, you are responsible for the first $250.00 which is considered your deductible, and the remainder of the charges, the plan C under the AARP, is covered at 80% to a lifetime maximum benefit of $50,000
PLAN D
Plan D works like plan C, but is different in what it covers. Plan D does not cover the Part B deductible (medical) of $135.00 annual.
Plan D covers the following Items:
- Covers the Part A deductible of $1068.00 per benefit period. You may be asking yourself what they mean by a benefit Period. According to Medicare a Benefit Period is every 60 days, so for example. If you fractured your arm in Dec and then sprained something else in January, you would still be in your benefit period. But if you sprained something else in Feb or March then it would be considered a new benefit period and dependent on the plan you have you would have another deductible to meet.
Most average persons don’t have $1068.00 lying around to pay the Part A deductible, so most people when getting a Medigap policy always look to have the Part A deductible covered.
Plan D also covers the skilled nursing facility co-insurance as I stated earlier Medicare covers the first 20 days and the plan covers days 21st thru 100th.
Plan D also covers the first 3 pints of blood, which goes for Part A which is Hospitalization and Part B which is the Medical portion.
Plan D does not cover the PART B DEDUCTIBLE of $135.00 annually.
Plan D does cover the 20% of eligible medical expenses and Medicare generally covers the other 80%.
Plan D also at home recovery services not covered by Medicare such as home care certified by your doctor for personal care during recovery from any injury or sickness for which Medicare approved home care treatment plan, how it works is like this.
The Plan D will cover actual charges up to $40.00a visit; up to a number of Medicare approved visits not exceed 7 each week to a calendar year maximum of $1600.00
Plan D also covers the foreign travel benefit as well
Plan E
Plan E covers the following:
- Hospitalization deductible of $1068.00 for the 1st 60 days ( benefit Period)
- Skilled Nursing Facility Care from days 21st to 100th, Medicare covers the first 20 days in full, after day 21 Medicare covers all expenses except for $133.50 and the plan covers the 133.50
- Blood the first 3 pints.
- Like plan D plan E does not cover the Part B deductible of $135.00, you are responsible for that.
- Plan E does cover the 20% of your medical expenses.
- Plan E also covers the Home health care at 20%, Medicare the other 80%
- The foreign Travel care as well
- An additional benefit is Preventative Medical Care BENEFIT NOT COVERED BY MEDICARE; THE Plan E covers that benefit up to $120.00 per calendar year.
Plan F
Now I don’t know if I am bias, but plan F has always been my favorite. Why you may ask, because it covers all major benefits that most people are looking for with the exception of a drug plan. Plan F is perfect for most persons.
Keep in mind that there no longer is a Medigap plan that covers prescription drugs, which was done away with back in 2006, when Medicare came out with The Prescription Drug Plan, or better known as PART D.
PLAN F covers everything plan C covers plus the Foreign Travel Benefit, and an excess charge benefit as well at a 100%.
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