Choosing a Medicare Solution…There’s a LOT to Consider!

There is a lot to consider, like:

  • What insurance do you have now?
  • Does your employer offer any options when you retire?
  • How does your choice affect your spouse/partner?
  • What medications do you take and what will they cost on a Medicare plan?
  • Do you have any upcoming procedures?
  • How much will your drugs costs when you transition from pre-65 health care to Medicare?
  • What are YOU looking for in your plan?
  • Is self-directed care important to you or do you prefer to rely on medical professionals to direct your care?

Both Original Medicare and many Medicare Advantage plans allow for self-directed care. So, if you want to self-direct your care, you have options in the Medicare Advantage world. Supplements are no longer the only game in town. Medicare plans have changed dramatically in the past decade. It is a competitive marketplace with many good choices. Over the past decade, advantage plan and drug plan costs have been declining while supplement premiums have mostly risen. One important consideration is your primary care choice if you choose an HMO. This person will be particularly important to you and will be responsible for coordinating your care. It is important you make a good choice for YOU. The majority of Medicare Advantage plans in our area do NOT have Medical deductibles or drug plan deductibles. Medicare Advantage plan coverage is always available when you travel in an urgent care or emergency situation. Advantage plans are similar in concept to employer plans that many people have been familiar with most of their lives. Fact-check things you’ve heard – especially things like “too good to be true” and “you get what you pay for.”

Know What You Don’t Know

At MedicareBear, we believe that choosing a Medicare solution should be the by-product of a thoughtful process.

We have helped more than a thousand of your neighbors find their best solution, and we can help you, too. In our experience, most people don’t want to become experts. They want to trust a competent advisor. Trying to become an expert might paralyze you, so we recommend that you call us instead of feeling unnecessarily overwhelmed. You have an enormous number of choices available to you. If you go to medicare.gov and put in our zip code, 34667, here’s what you’ll find: 18 Insurance Companies, 100+ Plan Combinations, 78 Advantage Plans, 28 Drug Plans, 12 Letter Types (Supplements: A,B,C,D,F,G,K,L,M.N plus High deductible versions of some lettered plans)

All plans that are offered on Medicare.gov are adequate. They are required by law to meet STRICT standards set by the government. However, if “adequate” is not your goal and you’d prefer to have someone help you separate the best plan for you from the rest of the chatter, confusion and noise, contact us. Transitions create opportunities and confusion. We can help you choose a plan while you’re operating from a position of strength with all the facts. KNOWLEDGE IS POWER! The financial dynamics of Medicare have changed dramatically in the last few years. You want to be on the right side of this transition! “Old” plans still exist. Are you on one? If you enrolled in a Medicare Advantage Plan five or more years ago, you should be aware that the playing field has changed dramatically. Over the past decade, advantage plan costs and drug plan costs have been reduced, while supplement plan premiums have continued to rise. If you haven’t REALLY taken a hard look at your plan in a while, you should. Contact us. Plans called “Part B Premium Reduction Plans” or “Givebacks” are available in our Medicare market. Dollar amounts associated with specific plans and companies are NOT notated on Medicare.gov. You can either call each company, or contact MedicareBear.

Medicare Advantage Plans in a Nutshell

  • Managed Care Systems
  • HMO (local)
  • PPO (regional)
  • Premium?
  • Medical Deductible?
  • Co-Pays?
  • M.O.O.P.P. (Maximum Out Of Pocket Protection Limit)
  • Ancillary Benefits: SOME include hearing, vision, gym membership, transportation to and from facilities, etc. (vary)

There is a lot of confusion regarding Medicare Advantage plans. We have heard many myths and cleared up many misunderstandings for our clients.

We hear things like:

  • “You do not have coverage if you travel”
  • “you get what you pay for,”
  • “it’s too good too be true”
  • and we have even heard “all plans are alike…”

These ideas are WRONG!
TRUTH: Emergency and urgent care is always covered, even when you travel. In EVERY PLAN that you see on medicare.gov.
TRUTH: Coordinated care can work very well for many people. Some premier medical institutions have used this model for decades, like Mayo Clinic. Mayo Clinic uses a managed care system.
Get the facts at MedicareBear.com

How Medicare Part B Giveback Plans Work

How do giveback plans work?

The insurance company reimburses a portion of your Part B premium, so they’ll take less out of your check every month. Part B Givebacks are coordinated through your Social Security and Medicare Part B premium payments. Part B giveback plans are not all alike and the reimbursements can be as much as $170 per month in our area.
Giveback plans work well for many and are often a good value.

Do they work? You betcha!
Are they popular? With our clients, yes! Very!
Are they all alike? NO!
Do they work well if I have special needs like diabetes, COPD, or a heart condition? YES, and THEY MIGHT BE A PERFECT FIT!

Secondary Insurance (aka Supplement or Medigap)

Secondary Insurance

Medicare supplements (Medigap or secondary) insurance plans are available in a standard format based on alphabet letters. The Plan Letter = Benefits (All Plan Gs, for example, regardless of the company offering the plan, have exactly the same base Medicare benefits.) Premiums vary WIDELY and are set by each individual company.

Premiums are paid monthly ON TOP OF your Part B premium. You pay monthly premiums whether or not you use the coverage. With Original Medicare and a Medigap plan, your care is self-directed.  No referrals are required. Your supplement will generally be accepted anywhere Original Medicare is accepted. There generally is no defined or restricted network of doctors or facilities.

The “Sunk Cost” Trap

“I’ve put this much into it, so I’ve got to hold on to it until it pays off” is the Sunk Cost Trap. A Medicare supplement was once the only option for protection against the holes that Original Medicare leaves behind if beneficiaries have just Original Medicare and no other coverage. However, in 2003, Medicare Advantage Plans were introduced, and they provide an affordable Medicare option for many people. Medicare Advantage Plans are relatively new, and new things take a while to catch on. The traditional model of supplements was a “pay me now whether you need me or not, but pay me no more.” The Advantage Plan model is “pay-as-you-go,” in the form of co-pays. If you don’t use services, you do not have to pay anything.

In comparison to plans that charge a monthly premium whether you use them or not, it is not difficult to see why some might try to make the point that “you get what you pay for” and by that logic, advantage plans look “cheap.” But quality health care that you can comfortably afford is not cheap at all; in fact, having the peace of mind that you can afford the insurance plan you choose regardless of unpredictable circumstances is priceless to many of our clients. ”Getting something for nothing” “no free lunch” “get what you pay for” …these are all scripts that we have heard to discount the value proposition advantage plans offer…BEWARE OF THIS TRAP!