Good Day Toni:
I am turning 65 in August and need helping deciding the best way to get my Medicare, if it should be “Original Medicare” or a Medicare Advantage Plan. How do I know what is best for me? Louis from Missouri City.
Oh Louis:
I get asked this question at least 10 times a day and this is what I tell my client when they are trying to decide which way is best to select their Medicare. Look at pages 48-49 of the Medicare & You handbook, which discusses the two main Medicare coverage choices. To find which policy is best, depends on which is best for your own health situation. You may be someone who only goes to the doctor once a year and 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. Take your time and search your options. Here are the steps to help you decide what is right for you:
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 main difference between “Original Medicare” and Medicare Advantage plans is “Original Medicare” works only with Medicare and generally, you or your supplemental coverage pay the deductibles or coinsurances.
A Medicare Advantage plan is also call 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. 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. If you choose a Medicare Advantage plan, please make sure that the plan has Part D Medicare Prescription Drug coverage included. Check out page 49 of the Medicare & You handbook because it will guide you through all of your choices or email me at asktoni@medicaretruths.com for some more pointers.
Step #3:
Decide if you want supplemental coverage. You may want to get coverage that fills the gaps in “Original Medicare”. You can choose to buy a Medigap/Medicare Supplement policy from a private insurance company. Cost will vary by policy and company. Employers/unions may offer similar coverage. See pages 57-59 of the Medicare & You handbook for information on Medigap/Medicare Supplement policies.
There is an important disclaimer at the bottom of page 49 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.”
Toni King is an advocate/consultant for those “Confused about Medicare”. She encourages her reader to email questions to asktoni@medicaretruths.com . Whatever your Medicare problems are she will find you the answer. Visit her website www.medicaretruths.com.
