Choosing a Medicare Plan
Picking a Medicare Plan should be as stress-free as possible. There are several plans to choose from and not selecting the right one can do more harm than good. Our insurance agents are here to guide you through the process and ensure you’re enrolled in the policy which will best fit your needs.
Original Medicare or Advantage Medicare
Original Medicare with a Medicare Supplement and Part D prescription plan is a good option for people who want to see any doctor nationwide that accepts Medicare, or want a supplement that will cover most or all of the copayments and coinsurance associated with Original Medicare.
For those who want additional coverage added to their plan with typically a lower monthly premium, Part C (Medicare Advantage) might be the best option. Part C plans can include dental, vision, and hearing benefits, while also providing the same coverage as Original Medicare. They also have different varieties, such as HMO and PPO.
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Need Medicare Supplements?
There are ten Medicare Supplement Plans to choose from: Plans A, B, C, D, F, G, K, L, M, and N. They can only be used when you are enrolled in Original Medicare as they cover the costs Original Medicare does not cover. As seen below, each plan provides coverage for different costs:
• Part A coinsurance and hospital costs: Plans A, B, C, D, F, G, K, L, M, and N
• Part A hospice care coinsurance and copayment: Plans A, B, C, D, F, G, **K, **L, M, and N
• Part A deductible: Plans B, C, D, F, G, **K, **L, **M, and N
• Part B coinsurance and hospital costs: Plans A, B, C, D, F, G, **K, **L, M, and N
• Part B excess charges: Plans F and G
• Part B deductible: Plans C and F
• Skilled nursing care facility coinsurance: Plans C, D, F, G, **K, **L, M, and N
• First three pints of blood for transfusions: Plans A, B, C, D, F, G, **K, **L, M, and N
• Foreign travel emergency care (80%): Plans C, D, F, G, M, and N
**Plan K only provides 50%, **Plan L provides 75% percent, and **Plan M provides 50% coverage.
What About Prescription Drug Coverage?
Even if you don’t have any current prescriptions, you should enroll in a Part D prescription drug plan to avoid future premium penalties. These plans can be bought as a standalone plan with your Original Medicare coverage, or it can be included in a Medicare Advantage Plan as an additional benefit.
Each Part D plan has a formulary, or list of drugs, that they cover. Before choosing a plan, you should always consult an agent, like those with Midwest Trusted Benefit, to ensure you will be getting the proper coverage. However, all Part D plans cover vaccinations that are used to prevent illness. They also cover anticancer, anticonvulsants, antipsychotics, antidepressants, immunosuppressants, and HIV/AIDS drugs.
Take a Look At Costs
While finding a plan that meets your coverage needs is important, finding a plan that meets your budget needs is also a big determining factor in what plan you choose. Let’s take a look at some of the costs you can expect for Medicare in 2021:
- Premium: Most beneficiaries get premium-free Part A, but for those who don’t, they can pay anywhere from $259 to $471.
- Hospital Inpatient Deductible: $1,484 for each benefit period
- Hospital Inpatient Coinsurance (for each benefit period):
- Days 1 – 60: $0
- Days 61 – 90: $371 per day
- Days 91 and over: $742 per day
- Premium: $148.50, but can be higher based on your income.
- Deductible and Coinsurance: $203 deductible, then 20% of the Medicare-approved amount for most services after deductible is met.
- A few Medicare Advantage Plans pay part or all of your Part B premium, but if your plan does not, you will have to continue to pay the Part B premium.
- Plan Premium: You pay the monthly premium to the insurance company which can be as low as $0.
- If your plan has a deductible you will need to pay this before benefits kick in.
- Most plans have copays for some medical services that you pay at the time of treatment.
- Coinsurance will be required for some medical services up to 20%.
- Maximum Out-of-Pocket for healthcare ranges from $3,900-$7,550 depending on the plan you select.
- If your Medicare Advantage Plan includes drug coverage, your prescriptions copayments and coinsurance costs are separate from the health Maximum Out-of-Pocket.
- Premium: You pay a monthly premium to the insurance company that can be as low as $7 or as high as $100, depending on the plan you choose. Those with a higher income will pay more.
- Maximum Deductible: $445, but some plans have no deductible.
- Copays and Coinsurance: Prescriptions are rated from Tier 1-5 with different cost sharing per tier.
How Do I Decide?
After going over the different costs/coverage of each path and how each function, we sum things up with a statement of “Paying In Advance” vs. “Paying As You Go”.
Some clients will prefer to have Original Medicare with a Medicare Supplement Plan G and Drug Plan and are okay with the fact that they are paying more per month for the fact that if something with their health comes up, they will pay very little in out-of-pocket costs after the fact. Hence the statement “Pay In Advance”.
Other clients will be attracted to a Medicare Advantage Plan for its lower cost per month with included ancillary benefits. These people are willing to accept the responsibility of the out-of-pocket costs they will incur if something comes up with their health. Hence the statement “Pay As You Go”.
Trying to pick a Medicare plan might feel impossible when staring at all the different options. That’s why it can be helpful to work with an insurance agent who can do the research and present you with a plan that will fit your insurance needs.
If you’d like to make an appointment, you can contact us at 402-740-5505, and we’ll assist in any way we can.