Dear Toni,
This is my first Medicare open enrollment and I don’t know anything about this process? 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 page 17 of the 2015 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 Medicare option is best, depends on which option 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 a Medicare plan, there is not a one size that fits all or a best plan. Take your time and search your options.
Here are the 3 steps I use when helping my clients decide which Medicare plan meets their specific needs.
Step #1: Decide if you want “Original Medicare” or a “Medicare Advantage” plan.
- 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. The most accurate way to check for a provider is from that specific company’s website.
- 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.
- 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 Medicare Part D prescriptions drug coverage.
- If you want Medicare Prescription Drug coverage to go along with “Original Medicare” then you must enroll in a standalone Medicare Part D plan with a private insurance company that is approved by Medicare and usually there is a premium.
- If you choose a Medicare Advantage plan, please make sure that the plan has Part D Medicare Prescription Drug coverage included.
Step #3: If you chose “Original Medicare you may want Medicare supplemental (Medigap) coverage.
- Medicare Supplements fill the gaps of “Original Medicare”.
- You can choose to buy a Medigap/Medicare Supplement policy from a private insurance company. Cost will vary by policy and company.
You have until Sunday, December 7th to make your Medicare plan choice to begin January 1, 2015 that will last until Medicare Open Enrollment next year.
Toni King is the author of the Medicare Survival Guide which is available only at www.tonisays.com . Toni is an advocate/consultant for those “Confused about Medicare”. Email questions or to consult or make an appointment with Toni and her team about your Medicare needs to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
