Medicare with Other Health Insurance
Question: Hi Connie, this is ALL NEW to me (Medicare Supplement/Advantage Plans) I know you sell insurance for a living, however it appears from your site that you do have an interest in the recipients (and THEIR best interests) - so - let me fire this at 'ya.
I am 67 years old now. I've been enrolled in PART A since 65 (however, never used it) Now that I'm being forced to retire (due to hearing loss) I will NOT have a GROUP health plan available to me after May 31. Medicare has told me that I may sign up for PART B after March 1 (but before May 1) in order to have coverage by June 1.
Since I am a Service Connected Veteran, I do have VA medical benefits available to me should the need arise, however would prefer to use an outside provider for health maintenance and less serious health matters (including medications) The Advantage Plans that I've looked into will provide this for my Medicare Premiums (NO EXTRA COST. )Bearing in mind that you are an insurance salesman; would this not be my best route?
Answer: Even though I AM a salesperson, I'm not going to try and sell you any particular thing! But I will try to help you answer your question.
There are several points you need to consider to make the best choice for YOU! They all revolve around cost and convenience.
The most convenient option is original Medicare (A&B) paired with a Supplement and Drug plan. You can go anywhere you want and with the exception of some copays for drugs, your medical treatment will be covered 100%. This option will run you about $250 /month (in Texas) in premiums, including your Part B premium (assuming you make less than $85,000 single/ $170,000 jointly)
The next level of convenience would be original Medicare (A&B) plus your VA benefits. In most cases VA only pays if you get services directly from them. How far away is the VA facility from you? Medicare A has a deductible of $1132 per hospitalization for 2011. Medicare B (outpatient) has a deductible of $162 for the calendar year 2011. After that, you pay 20% for outpatient services. If you use the VA you will have little if any out of pocket cost based on how you are entered in the system. VA will provide prescriptions by mail order with little or no copay. Should you use Medicare B for doctor visits you may go where you want (as long as they accept Medicare) and it will cost you around $20- $40 for a typical office visit after deductible. Your cost would be your Part B premium of $115.40/month for 2011 and whatever your arrangement with VA is. You would have the risk of the additional A & B costs I mentioned. (This is the option my dad uses)
The least convenient would be a Medicare Advantage plan. You assign your part A & B Medicare to the company you enroll with and you must go to their in-network providers to realize the benefits from the plan. You may not revert to your original Medicare if you are unhappy except at certain times of the year. If you are healthy and are just seeing the doctor a couple times a year for checkups, this can work very well. Of course you don't really have insurance for those situations. You have it for the emergencies and catastrophic events. Advantage plans make money by managing the care they allow members to have. They may be generous with the little expenses but when it gets to the big expenses, they are tightly managed. I haven't talked to anyone who has gone through a catastrophic event in an Advantage plan that was happy with the service provided by the plan. If you're aware of this and the cost outweighs the possible inconvenience, this could be the best option. You do have the risk of out of pocket expenses of up to $5000 in-network with most Advantage plans. If you go out of network your cost risk is unlimited. If an Advantage Plan is the route you choose, ask lots of questions about what is and is not covered as well as what out of pocket expense risk there is, before enrolling. Also check the provider list for providers in your area.
Some other points to consider
Getting VA to pay in an emergency situation outside VA facilities is difficult. This is also the case with an Advantage plan. With the Medicare/VA option you at least have the flexibility of being treated anywhere with your Medicare and Medicare paying a substantial portion of the cost. With the Advantage Plan option, if they don't pay, it's your bill.
You didn't mention if you qualify for any special assistance based on your income or the hearing loss. Have you checked in to that?
Enroll in Part B early rather than late! You will need to call Social Security ( 1-800-772-1213 ) to do that and often they can take care of enrollment over the phone. You may also get information about special help because of the disability or income level from them. The sooner the better!!
I hope this helps you answer your question. Please let me know if I may be of further assistance. I can help you with Supplements, Drug plans and Advantage plans so when you decide on the route you want to take I hope you will consult with me.
