Dear Toni,

I will be turning 65 on January 23,2013and absolutely don’t know anything about Medicare, how to apply, when to apply where to apply? How to select to what and when?? Which program is good and which one is not? I do have some health problems and am concerned I am making the correct choice.
If you can show me direction and help me, I will really appreciate your help.

 Thanks Fred from Katy

Dear Fred:

I am asked this question at least 20 times a week and this is what I tell my clients when they are trying to decide which option is best for their Medicare.  Look at pages 56-58 of the 2012 Medicare & You handbook, which explains the two main Medicare coverage choices: Either “Original” Medicare with a Medicare supplement or a Medicare Advantage plan.

To find which policy is best, depends on which is best for your health situation.  You may be someone who only goes to the doctor once a year or you might be someone who has a long history of health issues. When it comes to Medicare, there is not a one size fits all or a best plan.  Take your time and search your options.

Here are the 3 steps to help you decide what is right for you:

Step #1:  Decide if you want “Original Medicare” or a Medicare Advantage plan.

a. Talk to your doctor and see which plan he/she recommends.  Many doctors are accepting “Original Medicare” and not Medicare Advantage plans.

If you have a doctor that is in the Medicare Advantage plan’s provider directory, make sure you call  to verify that he/she is still accepting that particular Medicare Advantage plan.  Sometimes providers are in the directory, but stopped accepting the plan long before it went to print.

b. The main difference between “Original Medicare” and Medicare Advantage plans is “Original Medicare” works only with Medicare and generally, you or your supplemental coverage pays the deductibles or coinsurances.

c. A Medicare Advantage plan is also called Part C and is administered by private insurance companies that are approved by Medicare.  You must use that insurance company’s card not your Medicare (Red, White and Blue) Card.

Step #2:  Decide if you want prescriptions drug coverage, also known as Part D.

a. If you want Medicare Prescription Drug coverage to go along with “Original Medicare” then you must enroll in a Medicare Part D plan with a private insurance company that is approved by Medicare and usually there is a  premium.

b. If you choose a Medicare Advantage plan, please make sure that the plan has Part D Medicare Prescription Drug coverage included.

Step #3:  Decide if you want Medicare supplemental (Medigap) coverage.

a. You may want to get coverage that fills the gaps in “Original Medicare”.

b. You can choose to buy a Medigap/Medicare Supplement policy from a private insurance company.

c. Cost will vary by policy and company.  Employers/unions may offer similar coverage.  See pages 66-69 of the 2012 Medicare & You handbook for information on Medigap/Medicare Supplement policies.

**There is an important disclaimer at the bottom of page 57 of the handbook and it states:  ‘If you join a Medicare Advantage plan, you don’t need a Medigap/Medicare supplement policy and if you already have a Medigap/Medicare supplement, you can’t use it to pay the out of pocket or co pays for the Medicare Advantage plan’.  It also states that “if you already have a Medicare Advantage plan, you can’t be sold a Medigap/Medicare supplement policy.”** 

Enrolling in Parts B and D can be very tricky and I will discuss how to enroll the correct way next week, so the rest of your question, “How to Enroll in Part B”, will continue until next week, but for right now Fred you can work on your options whether “Original Medicare” or a Medicare Advantage plan is right for you.

Toni King is advocate/consultant for those “Confused about Medicare” send Toni an email at or call 832/519-TONI (8664).  Visit her website for answers to other Medicare questions or to read other Medicare articles published in a HCN newspaper.

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