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Navigating Medicare

  • Isn’t Medicare free?
  • Medicare pays for everything, doesn’t it?
  • I’d never sign up for an HMO plan.
  • Why would people pay all that money for supplemental coverage?

I hear a lot of interesting things about Medicare, but I can understand the confusion. When I started learning about Medicare I had a lot of questions too. Now, almost ten years later, I’ve learned a lot about Medicare and what you should know about it. Here is what I feel are the most important things to know about Medicare.

There is no Maximum Out of Pocket on Original Medicare.
Medicare provides pretty good coverage. It has low deductibles, and only 20% coinsurance cost on the medical portion, so if Original Medicare had a reasonable Maximum Out of Pocket (MOOP) then it might make sense to have only Original Medicare (plus a drug plan, vision and dental). But Medicare doesn’t have a MOOP. For me that means I have to sign up with an advantage plan, or add a Medigap (Medicare Supplement) plan, not to do so means I’d take on almost unlimited risk. Why, because the 20% coinsurance means I’d pay 20% of … whatever the bill is. Can medical bills get high? Oh, yes, they can get high.

Is it the doctor or the benefits?
You need to get your priorities straight, do you need to keep the doctor(s) that you have, or can you move on and look for the best benefit package. This will help you to decide if you want to be on a supplement plan or an advantage plan, and can help you narrow down your choices of advantage plans.

HMO plans are not the end of the world.
I get it, many people didn’t grow up with HMO coverage, or have heard bad things about them, like I said, I get it. But you know what, if you’re on a supplement plan then you are still going by rules, Medicare’s rules. That means that whatever you want to happen has to be “Medically Necessary”, and Medicare decides if it is necessary.

An example:

Client X has had cancer. His doctor, with a university group, wants to perform a procedure every year to make sure that the cancer has not returned. If the client was on an advantage plan the doctor could request the procedure and depending on the groups decision, he might get it. But, since the client is on Medicare, Medicare could deny the procedure if their data shows he only needs to be checked every three years. This doesn’t mean that Medicare is bad, and that the university group is good, it does mean that everyone has to follow rules. If you join an HMO, make sure you’re comfortable with the network of doctors available, and remember, you can change networks during your coverage.

Get the help you need with your Medicare plan today by calling Jim at (714) 418-4040 or click here to schedule a consultation online.


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