AMAC, Inc.

You are turning 65, what are your health insurance options?

Congratulations! You are turning 65. You’ve worked hard for many years, and with that comes new opportunities and choices on how you can receive your health insurance coverage.  After all, you’ve earned these benefits, and deserve to enjoy the next good years of your life, resting assured that you have chosen the right coverage.

So what are your options?  For most, Medicare can be confusing and many seniors are not aware of the benefits they are entitled to.

Medicare is a federal program offered to individuals who have turned 65 or have been disabled for 24 months.  However, there are certain criteria that must be met in order to receive the various parts of Medicare.  The information below will highlight the most common  parts of Medicare (A, B, and D) and provide a brief overview of how a Medicare Supplement works, as well as Medicare Advantage Part C Plans.

MEDICARE PART A includes your hospital coverage.  You or your spouse must have worked 40 quarters to receive this benefit at no cost.  If you have not reached the 40 quarter mark, your monthly premiums will range from $244 to $443 per month.  Part A comes with various deductibles and out of pocket expenses.  There is an initial deductible of $1,068 per benefit period which covers the first 60 days.  If you need additional days in the hospital, days 61 to 90 will cost $267 per day.  After 90 days you will be responsible for $534 per day.  As you can see, Medicare Part A gives some necessary hospital coverage you may require.

MEDICARE PART B is mainly your doctor coverage.  Part B has a monthly premium and depending on your income these premiums can range from $96.40 to $308.30 per month.  Many choose to have these premiums deducted from their monthly Social Security check.  Part B includes an annual deductible of $135 and you are responsible for 20% of your doctor and outpatient costs.  In order to qualify for a Medicare Supplement or Medicare Advantage Plan, both A and B must be in place.

Now that you know about Hospital and Physician coverage, let’s take a look at PART D, which helps to cover your prescription drug costs.  To receive this coverage you must choose and enroll into a Part D prescription drug plan from a private insurance carrier.  Depending on the carrier chosen, there is a monthly premium as well as deductible and co-pays for these prescriptions.  Part D plans include certain phrases of prescription drug coverage.  These phases are initial, coverage gap, and catastrophic coverage.  Each phase has certain criteria that determine your out-of-pocket expenses for prescriptions.  There are also programs available to assist you with paying for your Part D premiums.

Once you have taken a basic look at Medicare, most newly eligibles start to think about ways to cover the gaps of coverage.  Let’s take a look at the various ways to cover these gaps – one option being the Medicare Supplement route.

MEDICARE SUPPLEMENT plans, sometimes referred to as Medigap Policies, are provided by private insurance companies to help pay for some of the health care costs that Medicare does not cover.  These plans have a monthly premium to help pay for the co-pays, deductibles, and coinsurance.  These types of programs must follow Federal and State laws to protect you and they must be clearly stated as being a Medicare Supplement policy.  There are many different carriers available but all of them have a”standardized plans” which are categorized A through L.  The major difference between these plans among the insurers is usually the cost.

Other options available are the MEDICARE ADVANTAGE PART C PLANS.  These plans are health plans approved by the Centers for Medicare and Medicaid Services (CMS) and run by private insurance carriers.  Medicare pays a fixed amount each month to these companies for your health care coverage.  Medicare Advantage Plans provide your Medicare Health coverage and can include prescription drug coverage.  There are various plans to choose from and each plan offers different benefits and features.  Medicare Advantage Plans may also offer other benefits such as dental, hearing and vision benefits.  You can join the plan if you live in the plan’s service area, have Medicare Part A and Part B, and you do not have end stage renal disease.

Medicare Advantage Plans are also divided into HMOs and PPOs.  The major difference is that HMOs provide networks that you must visit where PPOs give the flexibility to visit out of network providers at a higher cost.

It is essential to look at the types of plans that are available to make sure the plan matches your needs.  Different plans are available in different locations.  One plan may offer benefits that you seek; however, that same plan may have higher deductibles and co-pays.  It is important to look at your personal current needs to find the plan that may be right for you.

There are certain areas that you should make a priority while evaluating a plan.  Here is a start for evaluation:

1. Can I see my present doctors and what will it cost me to see them?
2. Can I see any doctor of my choice?
3. What happens when I go into the hospital and what will it cost me?
4. Do I need referrals from my Primary Care Doctor to see a Specialist?
5. What types of exams or screenings are covered and what will they cost me?
6. Are my prescriptions covered and how much will I pay for them?
7. Will this plan cover me if I travel outside of my area?

Once you prioritize your needs, you can begin to narrow down the types of features and benefits that a plan must have to fulfill these needs.  Now that this is done you will have to do your due diligence to find the insurance carrier with a plan that matches your needs.  One might ask, “Where do I find the names of these carriers?”.  Your “Medicare and You” Handbook is a good start.  In the back portion of the book are listings of carriers that offer plans in your area.  You may also seek guidance from a professional insurance agent that is familiar with the various plans and has experience in working in the senior marketplace.

Although choosing a plan may seem overwhelming, take your time, research and speak with a professional on all of your different options.  Following these steps will put you on the right track to providing peace of mind with regards to your health needs.

For further information, please contact AMAC Senior Services at 1-888-262-2006.

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