Good morning all,
I hope everything is well in your world. Today is the first day of school for my youngest son, going to be a junior this year. Where did the time go and how do we make it go faster to get him through high school and out of the house? Just kidding, not really, maybe a little.
Today, I want to continue the breakdown of Medicare, in its current state, for those that are interested in the Medicare for All. This is not a political statement, just a breakdown of Medicare in its current state and how you will be affected. You cannot make a decision without the facts, so here it is a breakdown of Part C.
Part C is also known as Medicare Advantage. This is a privately insured Medicare plan. What this means is although you are enrolled in Medicare, instead of using your Red, White, & Blue Medicare card, you will use the card of whichever insurance company you choose. You must maintain Part A & Part B, but you must use the cards and networks of your insurance company. These plans work similar to traditional insurance that you are accustomed to currently.
Many Plans have no monthly premium and include prescription coverage as well. Some also include other coverage some Dental and Vision, things of that nature. The thing to keep in mind with a Part C policy is you are adding a third party to your healthcare. What I mean by that is with traditional Medicare your care is between you and your doctor. As long as it is an approved procedure if your doctor recommends it and you agree then you can get the procedure done. In a Medicare Advantage plan, you have to get authorization from the insurance company and if they deem it unnecessary, then you have to go another route. I am working with a client right now that has to get a painful procedure done on her back and the insurance company will not approve her getting anesthesia, causing her as much pain as the ailment itself during treatment.
These Plans have a maximum out of pocket of up to $6700 per year. If your policy has a drug plan included it is separate from this maximum out of pocket. The Drug Plan will follow the same guidelines as a standalone Part D policy; we will touch on that tomorrow. You will have co-pays for procedures and a 20% co-pay on durable goods. Diabetes supplies, CPAP, things of that nature. I have had a couple of calls from clients that had to get a procedure done and had a $275.00 copay and the insurance company paid $15.00 when we asked why they only paid $15.00 they stated it was because the doctor agreed to charge $290.00 for that particular procedure.
These plans are ideal for keeping a low monthly premium and do serve a lot of people well. The issue is if you have to use them then the costs could rise significantly.
Another concern about these plans is if you get sick with a serious illness, you cannot then switch over to a Medicare Supplement because you will be outside of your open enrollment period and would have to pass underwriting. I talk to many people throughout the year of wanting to go to a Medicare Supplement because the Part C plan they chose does not provide the coverage they need, or it is too expensive to use. Keep in mind that for the most part, you are locked into that particular plan for the year. CMS did just approve an Open Enrollment Period from Jan. 1st to Mar. 31st where you can switch plans but that is the only time you can do that unless you have a life qualifying event.
All of these scenarios are not meant to scare anyone, it is my responsibility to give you the facts and answer any questions about these plans. These plans serve millions of Americans well and they are very happy with their coverage, but these plans do have some limitations and before choosing one, it is very important you speak with someone that knows how these plans work and what may cost you money in the long run. I speak to people all the time that are interested in the “Free” Medicare plan and I have to explain to them there is no such thing as a free plan.
As always, if you have any questions please give me a call or shoot me an email, I will be glad to talk to you and give you the good, the bad, and the ugly on all of your Medicare options.
Do something nice for someone today, just because.
All the best,
Randall J. Lawson
The HgO Group
National Producer Number #9276045
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