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Medicare Maze: Don't Go It Alone

Daniel was turning 65 and had insurance where he worked. The first time Daniel called CarePartner was for a Medicare Part D plan, for his diabetes medications. CarePartner found three plans that would work for him, and he chose the Humana plan with Walmart. Daniel was quite satisfied with this plan and when open enrollment started he asked if we would find him a Supplemental Plan because he was going to enroll in Traditional Medicare. Now, this sounded like a pretty simple request until we started looking up supplement plans in his state, Minnesota.

Medicare is a Federal program that is administered in each state. The Federal Guidelines need to be followed; but, as it turns out, each state can adjust those guidelines to accommodate what they believe to be right for their citizens. CarePartner was able to find three supplemental plans that seemed to fit Daniel’s needs. When we looked into it further we discovered Minnesota has a unique way of proposing their supplemental plans, with a variety of combination choices that require a monthly premium of nearly $400.

This included Traditional Medicare Part A & B, Medicare Part D and a Supplemental plan. So, at CarePartner we decided to take a further look into Medicare Advantage plans and found five Medicare Advantage plans that combined all this into one policy. Daniel narrowed it down to two possible plans after we discussed his medications, lifestyle and finances. Daniel had several questions about how each plan would fit into his healthcare needs. Daniel’s next step was to discuss this with his medical team to make sure that his doctors and medical equipment company would be in network with the 2015 plan.

When looking for a Medicare Plan there are three things to consider. It doesn’t matter if you are looking into a Traditional Medicare Plan with Part A and B, then supplement it with a prescription drug plan and Medigap policy or going with a Medicare Part C. When combining your coverage in a Medicare Advantage plan it is important to consider three major criteria:

  • Medications: Make a list of all of your medications, dosages and how often you take them. When considering a plan, look up each and every medication you are on and see if it is covered and what the cost is. Make sure that the plan will provide those medications at a cost you can afford. Whether you go with Traditional Medicare and pick up a Medicare Part D or have it included in your Medicare Advantage, consider the cost, where the medication will be obtained: local pharmacy or mail order or both and if it is covered by the policy you are considering. Ask if there is a pre-authorization needed for any of your medications. Pre-authorization is when the doctor has to send information to the insurance company and obtain their approval of the medication, or a dosage that is not standard, before it gets covered. This may mean a delay in getting your medication.

  • Finances: What is your budget? What cost is reasonable enough to be affordable? In some instances it may still be more than you have planned for, but you might need to accept it because you need insurance. This may mean an adjustment in your budget. Consider the costs of the monthly premium, AND the copays and co-Insurance, if any, with your plan. Copay is where you have a set amount to pay with each visit to a provider. Co-Insurance is the percentage you owe for the use of the facility or service. Just because there is a on-cost premium does not mean that it is cheaper. Consider the total cost out of your pocket. If it is $0 premium, then you are paying for your insurance with each use of medical care. Copays, co-insurance, deductibles can be higher, so add up all the potential cost for the year to see if it truly is cheaper.

  • Travel: Why would you consider travel when making an insurance decision? When a provider you use isn’t in your network, you will be responsible for Out of Network costs and possibly billed for Usual and Customary charges. This is the prevailing cost of a medical service in a given geographic area. The travel does not have to be to another country, it can be simply to another town. Not all Medicare Advantage Plans cover the cost of medical care from county to county. Some have a geographic area that they are limited to. Consider this also: if you move from one town to another, call your insurance plan and make sure you’ll have coverage in that town. Otherwise, you should consider a different insurance plan.

Determining what insurance plan is best for your needs can be a daunting task. It takes time to read all of the information provided in each plan and then to compare one to another. CarePartner is here to help. We can wade through the paperwork and help you to evaluate the plans that best fit your needs so that you can choose the right one for you. Call 800-401-9357 to get your FREE CONSULTATION or sign up today.

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