Medicare Health Plans
Once you qualify for Medicare, it can be very overwhelming to decide on a plan. At Retirement Solutions of Marion County, our main goal is to simplify the entire process. We do this through a number of steps.
- 1. Reviewing any doctors that you may be currently seeing.
- 2. Reviewing your list of prescriptions that you are currently taking.
- 3. Most of all we review with you all of the costs involved.
You may be surprised at the number of options that are available to you regardless of health, age or finances. Below is a simple breakdown of the different parts of Medicare.
The Two Parts of Original Medicare:
PART A
Part A of Medicare generally covers a combination of inpatient hospital stays, rehab, and home healthcare. If you have worked either 40 quarters or at least 10 years of your life, you should qualify for Part A of Medicare at no cost. Any easy way to think of Part A of Medicare is to associate "A" with "Admission" for a hospital admission, where you at least have one overnight stay. Medicare covers the first 20 days of rehab (not to be confused with permanent nursing home stay, they do not cover that) for free. If you remain in rehab for over 20 days, this begins a "per day" co-pay.
PART B
There is a cost for Medicare Part B. The standard Part B monthly premium for 2022 is $170.10, although the cost can vary depending on your income. Part B is the portion of Medicare that is used the most. What does Part B cover? It covers primary doctor visits, specialist doctor visits, blood work, ER Visit's, outpatient surgery, etc. If you just have Part B alone (with no supplemental coverage), Part B will cover 80% of most costs, leaving you with the other 20%. On the surface 20% may not seem like a lot, but when you consider that Part B has no caps or limits on the amount of your total bill. In other words, your 20% portion can be of any amount. There may even be a rare occurence where a doctor will choose to add on an additional 15% to your total bill (these charges are also known as "access charges"). It's important to have protection for all of the charges. When we do our complimentary healthcare review with you will sit down and explain all of the options that you have.
PART C
Part C is also known as Medicare Advantage. These plans do vary in price, but some of them offer a zero monthly premium option. Depending on which state you live in there are a number of different kinds of Medicare Advantage plans. If you would like a breakdown of your particular city, state and zip please fill out the personalized request below to receive information on available plans in your area. A wonderful provision in most of these plans is that there is a maximum " out of pocket maximum", which means if your health takes a turn for the worst, the insurance company does have a maximum limit that you would have to pay out of pocket for. If you reach this limit, the insurance company that you choose will pay the rest of your healthcare costs for the remainder of the year. We service our client's health plans from all over the United States. For the majority of our clients in Florida, there are mainly two types of Medicare Advantage plans which are listed below:
- PPO's
- HMO's
What are some of the differences between an PPO and an HMO plan?
There are pros and cons to both types of plans. Here is a breakdown of how the plans would work in general if you selected one of them.
PPO's
PPO plans generally give you the freedom to choose your doctor. In most cases, your doctor will either the category of either being "in network" or "out of network". If your doctor is in considered in network, your copays will be lower, if your doctor is considered out of network, you will still have coverage but may pay a higher co-pay. PPO's will afford you more freedom than an HMO plan, but will typically have higher co-pays than an HMO. This type of plan does have an annual out of pocket limit for the year. Most of these plans also include in their coverage prescription coverage as well at no additional cost.
HMO's
HMO plans usually require that you choose a doctor from a specific list of a doctor directory. Whereas an HMO, will not afford you to have the freedom to choose your doctor like a PPO would, usually the copays in these plans are the cheaper than a PPO. This type of plan does have an annual out of pocket limit for the year. Most of these plans also include in their coverage prescription coverage as well at no additional cost.
PART D
Part D plans are the prescription plans that you can choose if you qualify for Medicare. This is usually the easiest part of Medicare to remember, if you just think of "D" as standing for prescription "drugs". You can choose a separate prescription plan that you can pair with a traditional Medicare Supplement. If you have a 'stand alone" prescription plan you will pay a separate monthly premium if it's not included in one of the zero premium "Medicare Advantage" plans that are available in most area's (Example the PPO and HMO plans listed above). Premiums can vary depending on a person's income level.
MEDICARE SUPPLEMENTS
Medicare supplements are health care plans regulated by the government. Your benefits are not determined by the insurance company, they are determined by the letter plan that you choose. Plans A-N, vary in price and benefits. That being said a Plan G supplement with one insurance company will work exactly the same as a Plan G with another company. Again, your benefits are determined by the letter plan that you choose whether that be a "Plan G" or a "Plan N". All traditional Medicare Supplements have a monthly cost. Because we are an independent agency, we will always shop around for you and make sure that we are offering you the cheapest premiums available.
If you would like a no-obligation review of your Medicare options, please call our office directly or fill out the online request below.
