10 Important Things

10 Important Things

Oct 10, 2015

To Know About Medicare Plans

It’s that time of year again. Time to look at the benefits of your Medicare insurance plan and decide to keep what you have or make a change. Here are 10 important things to think about when evaluating a Medicare Advantage insurance plan.

1. You must have Medicare Part A and Part B to be eligible AND you must continue to pay your Part B premium.

2. Joining a Medicare Advantage plan may affect your current coverage. If you have existing coverage or employer- provided health insurance and plan to work past 65, be sure to check to see how joining a Medicare Advantage plan could affect your current coverage. A Medicare Advantage plan can sometimes be less expensive than your employer provided plan. Most Medicare Advantage plans in Orange County have a $0 premium.

3. Once you stop working and you are 65 or over, you must have Part B of Medicare even if you have a retiree plan sponsored by your former employer. If you don’t take Part B when you are eligible, you will have a penalty when you decide to apply later.

4. The use of a network of health care and pharmacy providers is typically required with Medicare Advantage plans. Using providers outside of the network may cost you more. Make sure your primary care doctor and specialists are part of the network. And make certain the hospital you prefer is also in the network. In an emergency, you can use any provider or any hospital.

5. Depending on your financial situation, you may qualify for some help paying your plan premiums or Part D medications. This “extra help” comes on a sliding scale, so if you have any questions it is always a good idea to ask.

6. A Part D late-enrollment penalty is an additional amount that will be added to your Part D premium if you go without Part D coverage for longer than 63 days in a row after your Initial Enrollment Period. 

7. A Medicare supplement plan (Medigap policy) is not a Medicare Advantage plan and is not a “PPO” plan. Medicare supplement plans are health insurance policies and are secondary to Original Medicare. When you purchase a Medicare supplement plan you also need to purchase a Part D plan. When you have a Medicare supplement plan you can see any doctor that accepts Original Medicare.

8. When you have a Medicare Advantage plan you use that member ID card and not your Original Medicare card when receiving services. This is another “advantage” of this type of plan; you no longer need to carry your Medicare card with your Medicare/Social Security number.

9. Even though Medicare Advantage plans are privately administered, you still have the same rights and protections as with Original Medicare; and, Advantage plans cover all the services that Original Medicare covers and usually offer additional benefits.

10. The Medicare Advantage plans provide a built-in financial safety net with an annual out-of-pocket maximum. This assures you will never pay more than a certain amount out-of-pocket in a given plan year for covered medical services.

To sum it all up, if you can say yes to the following five questions, then a Medicare Advantage plan is a good choice for you: Is your primary care doctor in the network? Are your specialists in the network? Is your preferred hospital in the network? Are your prescriptions drugs covered? Is the plan affordable? Call me today and begin saving money with a Medicare Advantage plan.

Ruth Page

An independent insurance broker, Ruth Page is co-owner of Porter-Page Insurance representing AARP United Healthcare and Secure Horizons. She can be reached by calling
(949) 297-3917.

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