Medicare

Solutions health agents can sign you up for basic Medicare as well as discuss the pros and cons of using a Medicare supplement or an advantage plan, depending on your personal situation.

A Medicare supplement plan allows you to use any doctor who takes Medicare, but does not include prescription drug coverage, also known as Part D. Supplements do not change year to year in terms of coverage, but costs generally do increase.

A Medicare Advantage Plan is managed by a private company and usually includes Part D coverage along with added benefits like health club membership, limited dental and eye or vision. They do use networks, so you need to make sure that if you have favorite doctors or facilities, they are in the network or you will have to pay extra. These plans also have co-pays.

Selecting the right plan can by tricky; let us help you make the right decision.

A Medicare Supplement is used with original Medicare. Any caregiver that accepts Medicare will take a Supplement because they only need to bill Medicare. Medicare pays their part (generally 80% of Medicare covered benefits) and sends the remainder of the bill to the Supplement which pays their part (generally 20%). It is important to note that Supplements do NOT include Prescription Drug Coverage (Part D, PDP) and for those that do not get a PDP when first eligible there will be a penalty when they do get a PDP. (there are exceptions to this) A Medicare Supplement does not change year to year (although the cost does generally go up the coverage does not change).

A Medicare Advantage plan works differently than a Supplement. With a Medicare Advantage Plan a private company TAKES OVER for Medicare (you remain in the Medicare system but Medicare is no longer responsible for your bills). These plans follow the same type of module as many group plans such as HMO or PPO. With this type of plan it is important to remember several things. First, most Advantage Plans have Networks so you want to make sure your Doctor, Hospital, and auxiliary care are within the network. (otherwise you will be paying higher costs and in some cases are responsible for 100% of care outside the network) Second, Advantage Plans have co-pays associated with them. It is important to be aware of these because they can add up to be quite a bit of money. Third, most Advantage Plans have the Part D “built in” which is a nice bonus but you must be aware that when switching to a Supplement from an Advantage Plan you will also need to add a Part D. (there are several types of Advantage Plans that do NOT have the Part D built in so this is something you need to keep in mind when choosing any plan). Lastly, Advantage Plans typically have value added benefits. These benefits vary between plans but typical benefits include Health Club membership, limited dental, eye and/or vision.

Also, not all Plan D’s are the same. Although they are required to be at least as good as the Medicare model they can vary greatly in costs, co pays and specific drugs that are covered. It is important to check which one suits you and continue to check each year because they (like Advantage Plans) do change every year.

Because these plans vary even from county to county, we strongly recommend that you talk to an independent insurance agent to help you choose the one that best suits your needs.