Health Benefit Advisors

Medicare Overview

"Original" or "Traditional" Medicare refers to the government program covering hospitalization (Part A), plus doctor visits, surgeries, lab work and other services (Part B), but it does not cover all health care expenses. Prescription Drugs are generally covered by purchasing a separate Medicare Prescription Drug Plan (Part D). Deductibles and copays on hospital, doctor, and other services create a gap in coverage that can prove very costly if not covered with some type of supplemental plan.

Choosing the right coverage at any point in life can be confusing and making the wrong decision can be both costly and medically devastating. In general, whenever choosing medical coverage, factors you should consider include:

Cost of coverage – the monthly premium
Level of coverage – what is covered, what is not covered, your personal participation in medical costs
Provider access – which providers are in network, which are out of network, and how will that impact your access to the “best” care

Since changes in Medicare options happen each year, it is important to compare plans every year to secure the coverage that best fits your individual healthcare and financial needs for the upcoming coverage period.

In order to select the best possible coverage, you will want to consult with an advisor who specializes in helping people understand their local options as well as which plans might fit their unique situation. The best option is to meet with a broker who represents multiple carriers and can help you compare many different plans. This will ensure that you get an objective opinion about which plan may best suit your needs.

HBA’s comprehensive approach to guide its clients involves asking a variety of questions around the client’s “health”, “lifestyle”, and “budget”. The answers to these questions help narrow down the choices and allow the HBA team to make specific recommendations that will save time and money, and ensure that the subscriber selects the best plan for their needs.

Some very important points to remember about Medicare and the choices you make:

Some of the decisions you make may be irreversible even during open enrollment, so regarding your coverage elections, “hope for the best but plan for the worst”.
Rules and guidelines can vary significantly by state, so advice from your out-of-state friends may not apply.
Financial penalties for not following the rules will stay in place forever.
Medicare is always bought on an individual basis, and you and your spouse can make different choices.

Medicare recipients may secure extra coverage to fill the gaps in Original Medicare in one of two ways. One option is to purchase a Medicare supplement plan, also known as “medigap” coverage, which covers some or all of the benefit gaps in original Medicare.

Medigap coverages are offered by multiple carriers in every state, but the benefits are classified by the federal government as “Plan A” through “Plan N”. Every like-named Plan covers the exact same benefits, regardless of the carrier you choose. These Plans all cover various gaps in coverage that original Medicare doesn’t – like hospital deductibles, Part B deductibles, and various other gaps. HBA educates individuals on all the details, and helps you select the right plan for your health, lifestyle, and budget.

If you purchase a Medicare Supplement, you typically also purchase a separate prescription drug plan (Part D) to cover prescription costs.

Drug plans typically have their own “formulary” or list of drugs that are covered through the plan, along with an annual deductible and varying copays for generic, brand, and specialty drugs. They may also have different networks of pharmacies that are included/excluded from coverage. Every state has a different number of carriers offering coverage, and choosing the right plan can save individuals hundreds of dollars a year.

In addition, formularies, deductibles, copays, and networks all change from year to year, so shopping for the right plan should be an annual exercise for everyone.

HBA utilizes software that plugs in all your prescriptions, and automatically directs you to the most cost effective plan every year.

The alterative to original Medicare with a Supplemental Plan is to elect a “Medicare Advantage” plan offered through a private insurance company. Medicare Advantage Plans must give you at least the same coverage as Original Medicare. These plans will have network restrictions and often have copays associated with them but will usually have a lower monthly premium than a Medicare supplement. They will often include prescription drug coverage and can provide additional benefits that are not normally covered by Medicare such as dental and vision coverage.