Do Your Due Diligence When Selecting Medicare Options


Last posted by Gary Boatman | Observer Reporter

Annual enrollment is every year between Oct. 15 and Dec. 7.

Annual enrollment is when seniors on Medicare make decisions for the next calendar year. Everyone must go on Medicare when they reach age 65 unless they or their spouse are still working for a company with 20 or more employees.

Basic Medicare is an 80/20 plan with lots of deductibles. Because of this, about 98 percent of recipients have some type of supplement. There are two major types from which to choose. One is Medigap, the other is an Advantage plan.

Medigap covers some of the cost not covered by Medicare. Policies are listed under letters between A and N. The A plan of all companies covers the same benefits. But there can be a big difference in cost to the consumer. Squared Away Blog found that a 65-year-old woman in Houston, Texas, could buy a Plan C policy with the same coverage for $1,700 from one company and $5,300 from another.

Medigap policies allow you to go to any doctor who accepts Medicare and is accepting new patients. It is often suggested you should ask your doctor if he or she accepts Medicare a few months before turning 65. If they do not, perhaps you should look for a new doctor. Most doctors who do accept Medicare will allow current patients to stay on it once they turn 65. If you have Medigap, you will need an additional policy to cover Part D for prescription drugs.

Medigap is the biggest network of providers in the United States because you can go to a doctor anywhere in the country if he or she accepts Medicare and new patients. It may have fewer out-of-pocket costs. The negative is it is usually more expensive and does not cover some things an Advantage plan might cover. You also might not qualify if your health has worsened. There are no pre-existing conditions in the first six months you are eligible for Medicare, but there may be later.

Advantage plans, or Part C of Medicare, have networks of providers. Some are very large and some are quite small. They have lower monthly premiums, sometimes as low as a zero-dollar monthly charge. They may have some co-payments depending on whether the provider is in network or not.

Usually they have some prescription coverage built into them so they do not require an extra Part D prescription plan. Often, they offer benefits Medigap policies do not, such as health club memberships, glasses and hearing aids.

It is important to study your specific health-care needs when selecting what supplement you will purchase. It must cover the doctors you use and include enough specialists to cover changing health-care decisions. Formularies are the drugs that are covered by a particular plan. You must check to make sure the particular drugs you take are covered by your plan.

The difference can sometimes be thousands of dollars per year. If your medication changes during the year, you can adjust your coverage during next year’s annual enrollment period.

Choose your plan carefully and make sure the person who is helping you make plan decisions has access to both types of supplements and that the individual is checking multiple insurance companies to find the best economic fit for your health-care needs.

You also should do this review every year because changes in the plan may be made, and what was best last year may not be so this year.


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