Choosing the Right Medicare Health Insurance Plan

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There are many options when you are Medicare eligible. Medicare Parts A & B can be supplemented with a Medicare Supplement Plan. You could also pick a Medicare Advantage plan that usually has a lower cost and includes a PDP Prescription Drug Plan. But there is a lot of difference between Medicare Supplement Plans and Medicare Advantage (MAPD) Plans. Let us help you find the right plan for you!

Medicare Supplement vs Medicare Advantage Plans?

What is the difference between a Medicare Supplement plan and Medicare Advantage? That is a great question. Basically, the Medicare Supplement Plan F (most popular) steps in a pays all of the Medicare Eligible expenses for the client. That means you pay nothing in most every case! Medicare Advantage Plans are also known by their abreviation "MAPD" for Medicare Advantage Prescription Drug plans. have copays. They usually cost a fraction of the cost of Medicare Supplement Plans, but also your out of pocket expense can be much higher. So with a Medicare Supplement plan you "set it and forget it" while you pay copays for most every service with Medicare Advantage plans. Call Greg at (435) 767-1415 to get the details of the plans available in Utah, Nevada & Arizona.

AEP Annual Enrollement begins October 15 and goes until December 7th each Medicare season. During AEP you can choose a new Utah Medicare Advantage plan regardless of your health (except End Stage Renal Disease.) Let us help you pick the right plan to fit your specific needs.

Are you eligible for Medicare? Are you turning 65 in St George Utah, Iron County or anywhere in Utah? Let Greg help you pick the right Medicare Insurance plan for your needs. Maybe you have a loved one over 65, or someone under 65 who is eligible for Medicare and is in need of a Medicare Insurance plan? We can help you find out which plan would fit your needs. We offer Regence, SelectHealth, University of Utah Plan, AARP Medicare Complete, Molina, Sierra Spectrum & Humana (if available in your county).

Utah Medicare Advantage General Information
Serving all of Utah from Sunny St George

Call Licensed Insurance Agent Greg Davies today at (435) 767-1415

Terms and Abbreviations Discussed Below:
Medicare Part A - Hospital
Coverage for Medicare recipients
Medicare Part B - Outpatient Medical
Coverage for Medicare Recipients
Medicare Part C - Medicare Advantage Plans / MAPD
Medicare Part C Medicare Advantage Prescription with Prescription Drug Coverage
PDP - Medicare Prescription Drug Plan
HMO - Health Maintenance Organization
PPO - Preferred Provider Organization
HMO-POS - HMO with a Point of Service (out of network option)
PFFS - Private Fee For Service Plan that is an MA or MAPD with no network


Question: What is Medicare? How does it work?

Medicare is a federal health care program, managed by the Centers for Medicare & Medicaid Services (CMS), which provides health insurance to retired individuals regardless of medical condition and to certain people with disabilities. Original Medicare is a fee-for-service plan with two components, Medicare Part A and Medicare Part B. Medicare Part A provides coverage for hospital bills (inpatient hospital care, hospice care, and home health care). This is financed by payroll taxes, with no premium to beneficiaries who have at least 40 quarters of Medicare-covered employment.

The beneficiary pays a Part A deductible (that changes each year) for hospital stays up to 60 days, with additional copays required for each stay longer than 60 days. There is a Premium cost for Part B. or example in 2016 the cost is $121.80/month. The Part B cost for future years is announced each year near the end of the year.

The beneficiary pays a Part B deductible for treatment outside a hospital. they then pay 20% after the Part B deductible is met. There is no cap or out of pocket maximums in Medicare. For this reason many people choose a Medicare Supplement or Medicare Advantage Plan to help pay for what Medicare does not pay.

What is a Medicare Advantage Prescription Drug Plan (MA, or MAPD)?

Medicare Advantage is the name for a few different types of plans that contract with the federal government. Medicare Advantage plans include Medicare Managed Care Plan (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee-for-Service plan (PFFS) and Medicare Cost and other specialty plans. Essentially, these plans reduce out-of-pocket expenses and provide greater coverage than traditional Medicare alone, providing all the benefits of Medicare Parts A and B, plus additional benefits. The beneficiary continues to pay the Medicare Part B premium as well as any additional premium charged by the Medicare Advantage plan.

Many Medicare Advantage plans are offered at no premium in addition to the Part B premium. They can also include a Medicare Part D Prescription Drug plan benefit at little or no cost. They require copays for using services much as a "pay as you go" system.

Who is eligible for an MA Medicare Advantage or MAPD Plan?

Potential members need to be at least 65 years old or qualified as disabled by Medicare if they are under age 65. They must have Medicare Parts A and B, live within the plan's service area, and not have end-stage renal disease [ESRD]. If they do not have Part B, they are only eligible to purchase a Medicare Part D drug plan.

What should you consider before purchasing a MedicareAdvantage Plan?

Many Medicare Advantage (MedAdvantage MA or MAPD) plans provide coverage at no additional cost to the Part B premium. The Zero cost plans require copays and coinsurance but most have no deductibles.

There are three types of health care plans that help protect you from unexpected costs. Health Maintenance Organizations (HMOs) are managed care plans that require the member to use only contracted doctors and hospitals and typically referrals are required to see specialists.

Preferred Provider Organizations (PPOs) also have a contracted network of providers, but members can still see any provider that accepts Medicare patients and receive coverage. The plan pays more if you receive your care and services in-network. HMOs and PPOs offer increased benefits over Original Medicare such as physicals and vision care. HMOs and PPOs roll original Medicare benefits and supplemental benefits into one plan that usually also includes a prescription drug plan (PDP).

What is a Medicare Supplement plan?

Medicare Supplement plans are secondary policies to Medicare. With only a few exceptions, they do not have a network of providers. Medicare Beneficiaries pay a monthly premium and also need to purchase a Medicare Part D Drug Card also. Medicare Supplement (Medigap) plans help reduce your out-of-pocket medical expenses for unexpected medical costs associated with Medicare deductibles and coinsurance. This coverage can include the Part A and Part B deductibles and coinsurance, the skilled nursing facility coinsurance, as well as other benefits.

There are twelve standardized Medigap plans, labeled "A" through "L" each with different sets of benefits and premiums. Plan A has basic supplemental benefits, Plan J the most comprehensive. All plans include basic benefits but not all insurance companies offer all Supplement plans.

If you choose a "Select" C or F plan available in many markets, you would get a greatly discounted premium for agreeing to go to a certain network of Hospitals. Medicare Beneficiaries are still able to go to any doctor or provider that accepts Medicare.

Some companies have a "Select" C or F plan. You can choose this Medicare Supplement plan at a greatly discounted price and only go to Hospitals in the Network they specify. You are still free to see any doctor that accepts Medicare as payment for services.

What providers can I see on a Medicare Advantage Part C Plan?

With an HMO Medicare Advantage Plan members usually must get their health care from Network Doctors and Hospitals. In a PPO Medicare Advantage Plan members are free to see any contracted provider accepting Medicare patients but usually pay more for services from non-network providers. With a PFFSYour provider network booklet will show you many qualified providers to choose from. When a member chooses to see a provider that is not in our network, the member's share of the costs will be greater. Members are encouraged to see in-network providers to receive the best benefit from the plan and lower out-of-pocket costs. The opportunity for members to choose out of network providers for their care is one of the advantages of PPO or HMO/POS plan as opposed to a strict HMO plan that does not allow out of network coverage.

How do I choose between a Medicare Supplement Plan vs a Medicare Advantage Plan?

If you want 100% coverage of everything that Medicare doesn't pay, you might consider a Plan F Medicare Supplement plan and a Part D Drug plan. But the cost of such plans can be into the thousands of dollars a year even if you never see a doctor, go to a hospital or fill a drug prescription. On the other hand, a Medicare Supplemental plan gives the peace of mind that there is no additional cost in addition to the monthly premium. You would still need to purchase an additional Medicare Part D Drug plan (PDP).

If you want low cost or even Zero cost plan and only pay small copays and/or coinsurance as you receive treatment, a Medicare Advantage (MA or MAPD) plan might be right for you. And an MAPD plan usually includes a Prescription Drug Plan (PDP) at no additional cost.

It is very important to discuss your options with a qualified Licensed Insurance Agent.
Call us at (435) 767-1415 or (801) 406-9502 to learn more.

What do I need to look for in Medicare Part D Prescription Drug Plan?

Let us help you discover which Part D Prescription Drug Plan will work for you. We need to consider all of your current medications to see what plan would result in the lowest annual cost. You also need to see what the Generic copay is vs the Name Brand drug copays are on the plan. Some plans classify drugs in different categories. Other plans exclude some drugs altogether. The only way to know if a certain plan is right for you is to discuss it with a qualified professional. We would love to help!

What if I don't get a Medicare Part D Prescription Drug Plan when I am eligible?

If you choose not to purchase a Medicare Part D Prescription Drug Plan when you become eligible for Part A, then you would incur a penalty if you ever purchase a Part D Drug benefit in the future. The penalty is apx 1% per month for each month you go without a drug benefit. For example if you waited 5 years (60 months) before getting a plan, then you would pay approximately 60% surcharge compared to someone that had a drug plan in force without a gap in coverage. So if the national average for a Part D Drug plan is $35/month, then you would pay $35 x 1.60 or $56/month. And this additional surcharge NEVER GOES AWAY as long as you have a drug plan. The only way to stop paying the surcharge would be to drop the Prescription Part D drug plan altogether. But then the penalty continues to accrue until you purchase a Part D plan again. Let us help you decide if a Prescription Drug Plan (PDP) is right for your situation.

When can I change my Medicare Part D Prescription Drug Plan or Medicare Advantage (MA or MAPD) plan?

Starting in 2011, the Annual Enrollment Period (AEP) is October 15 to December 7th each year. During that AEP period, you can pick a new Part D Drug plan, or enroll in a MAPD plan. The effective date for the change would be the 1st of January following the AEP period. If you want to switch to a Medicare Supplement plan from a MAPD plan, you would have to wait until the AEP period.

What if I am on a MAPD plan and it cancels or decides not to continue the following year?

This would result in a Special Enrollment Period (SEP) that allows you to choose another MAPD plan available in your area, or switch to a guarantee issue Medicare Supplemental plan. That means that even if you have a serious health problem, and your MAPD plan cancels, then you can go on the Medicare Supplemental plan, or a Medicare Advantage plan without going through underwriting, or getting rated up for any health problems. This can be a very good situation for those that wish to switch but can't due to health issues.

When am I eligible for a MAPD Medicare Advantage or Medicare Supplement Plan?

There is generally a 7 month window for enrollment without a Part D Drug penalty. Three months before you turn 65, the month you turn 65 and three months after the month you turn 65. Example: You turn 65 on April 12. Jan, Feb and Mar + April + May Jun & July would be your 7 month Initial Enrollment Period (IEP). If you miss that IEP, you could start accruing a Part D Penalty. You are usually given 6 months after your birth date and still not receive a penalty.

What if I continue with my Employer Group Insurance plan past age 65?

Usually there would be no penalty accrued for not enrolling in a Part D drug plan after age 65 if it is done within the Medicare timeframe after you drop or lose your Group Health and/or Prescription Drug coverage. This is only true though if the Employer group plan was deemed "Qualified" coverage in that it was at least as good as the Part D plans as determined by Medicare. As soon as you decide to drop your group benefit or it is canceled, you would have 60 days to choose an MAPD or Medicare Part D Drug plan to avoid a Medicare Part D Prescription penalty from accruing. You would also be able to choose a Medicare Supplemental Health plan during those 60 days and get approved even if you have serious pre-existing health problems. Missing that 60 day timeframe would require you to qualify medically in an underwriting process with the Medicare Supplemental Plan. If you chose an MAPD, you can get covered regardless of your health during the AEP which is October 15 - December 7 each year. But you may have a gap in coverage if you miss your 60 day window after losing group coverage.

What if I receive a Medicare Disability prior to age 65?

In Utah someone under the age of 65 that is eligible for Medicare cannot choose a Medicare Supplement plan. They can however choose a Medicare Advantage plan if one is available in their county. They have a 60 day period following the month they are found Medicare eligible to choose a Medicare Advantage plan. They could also choose to not have a Medicare health plan in addition to Medicare benefits and only choose a Part D Drug plan (PDP). This allows them to avoid a penalty that would accrue for not having a PDP in place when they became eligible for Medicare.

What if I am under 65 and eligible for both Medicare AND Medicaid? (Dual Eligible)

This would mean you are "Dual Eligible" or eligible for a Special Needs Plan (SNP). There are different levels of Medicaid. If you eligible to pay nothing for your Medicaid, then you can change your MAPD or Part D plan as often as you like. If you do a "spend down" when it comes to Medicaid - or in other words you have to pay part of your Medicaid premium - you can only make changes to your MAPD or Part D drug plan during the AEP Annual Enrollment Period of October 15 to December 7 each year.

How do I choose which plan is right for me?

Contact Greg Davies - a qualified Licensed Utah Insurance Agent who specializes in Medicare Advantage, Medicare Supplement and Medicare Prescription Drug Plans in the Utah market. Greg has been in the Utah Insurance industry since 1997 and knows the plans that work well for Medicare Eligible Beneficiaries in Utah. Let Greg help you with any questions you may have in any of the above situations.


Greg Davies - Licensed Utah Insurance Agent


(435) 767-1415
40 N 300 E #203
St George UT
84770

Office also in
Wasatch Front
South Jordan, UT
84095

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