Dear Toni:
My mother is retiring and losing her company benefits. I need help finding a Medicare Advantage plan that can better meet her medical needs.
She receives $1,134 on her Social Security check and cannot afford to purchase a Medicare supplement. Can you give me some direction on what I can do to help my mother make a better choice in picking a Medicare Advantage plan? I look forward to what advice you have since you counsel people on Medicare every day.
Thank you, Becky from the Woodlands, TX
Hello Becky:
I know how confusing enrolling in the right Medicare Advantage plan is for your mother because I talk to clients every day who ask the same question. I also help my own mother!!
Here is step by step what you can do to help your mother make the best pick for her Medicare Advantage plans or Medicare health plans as it is called in the 2013 Medicare and You handbook:
1) Talk to her primary care physician or specialists to see which Medicare Advantage plans, they are still accepting.
2) Go to Medicare.gov which has the best tool for helping you narrow your search for a Medicare Advantage or Medicare health or drug plan.
- Click on “Compare Drug and Health Plans” and enter your zip code. You can use the plan finder to compare the different Medicare Advantage plans or even compare standalone (Part D) Medicare Prescription Drug plans.
- The Medicare Plan Finder can compare three (3) plans at a time. You can compare HMOs, PPOs, and PFFS plans.
- *Note Medicare plan finder only compares Medicare Advantage plans not Medicare Supplements.
3) With Medicare HMOs, there is less out of pocket, but you may have more restrictions because some Medicare HMOs must have “Referrals” and some HMOs have “Open Access” options which says that you can go to any specialist without referrals as long as they are in the provider directory, but you may have more out of pocket with an Open Access option.
4) Medicare PPOs and PFFS plans may have fewer restrictions, but may have more out of pocket for the freedom of picking in network or out of network providers. You will pay more for out of network providers.
5) Areas in the summary of benefits for Medicare Advantage plan you need to review:
a) Maximum out of pocket-This is the most she will have to pay in a year. Many are not aware that Medicare Advantage plans have maximum out of pocket.
b) Doctor/specialist co pays
c) Inpatient hospital care-
*Some plans have a single co pay such as $300 or 500 per stay (example only)
*Some plans are $175 co pay per day for 20 days which can be a maximum $3500 if you are in the hospital for over 20 days or might be $150 co pay per day for days 1-5 with a maximum of $750 maximum stay if you are inpatient hospital for more than 5 days (example only)
d) Outpatient services/surgery
*Some plans have 1 co pay for $100 per stay (example only)
*Some plans have 20% or 30% outpatient charge. (example only)
e) Ask what the co pay is for Chemotherapy or radiation. This may meet maximum out of pocket.
f) Prescription drug has a formulary with co pays so make sure her prescriptions are covered.
g) Skilled nursing out of pocket-this varies with each Medicare Advantage plan.
If you are still confused about her Medicare options, join me on Thursday night, April 18th at 6:45-8:45 for the free “Confused About Medicare” workshop at Leisure Learning located at 2990 Richmond(in the Greenway Plaza area), Houston, TX 77098. RSVP as seating is limited 832/800-4674.
Toni King, author of the Medicare Survival Guide which is on sale at www.tonisays.com. Toni is an advocate/consultant for those “Confused about Medicare”. Email questions to toni@tonisays.com or call 832/519-TONI (8664).
