MEET & GREET With Jill
Jill Clifford , Managing Agent
Join Jill at one of her local upcoming events!
Jill Will Be Covering:
* "ABCD's of Medicare" * Free Educational event on the basics of Medicare and your choices for coverage
* No cost nor obligation
MEET & GREET
Attend One Of Jill's Local Workshops and Receive Updates and Announcements 100% FREE!
September 26, 2024
10 am - noon
Auburn Annual Health Fair
Auburn Senior Center Gym 808 9th St SE, Auburn, WA 98002
October 5, 2024
1 pm - 2:30 PM
Auburn Public Library
1102 Auburn Way S,
Auburn, WA 98002
October 24, 2024
11 am - 2:00 PM
Health & Wellness Fair
25035 104th Ave SEKent, WA 98030
Sponsored By:Cogir of Kent, Senior Living
Articles Quick Access
The ABCD’s of Medicare – Medicare Advantage Plans by Jill Clifford
As of 2006, all Medicare recipients are required to have Medicare Parts A, B, and D, or credible coverage as good as the standard Medicare plan. Our Medicare coverage choices include:
1) Medicare Parts A & B with a Part D prescription drug plan;
2) Medicare Parts A, B, D, and add a Medicare Supplement plan;
3) a Medicare Advantage plan, with prescription drug coverage (MAPD), or without (MA) if we have other credible prescription drug coverage, like Veterans Affairs insurance, Tricare, or certain retirement plans.
Today we will discuss the third option: Medicare Advantage plans. To enroll in a MAPD plan, the individual must be enrolled in Medicare Parts A and B, continue paying Part B premiums ($164.50 monthly in 2023, unless Medicaid or someone else pays them, and live in the service area of the plan.
All MAPD plans have a maximum out-of-pocket limit (MOOP). When a MAPD individual has copayments (flat dollar amounts) or coinsurance (percentage of dollar amounts) that reach that out-of-pocket limit, the plan will pick up all of the Medicare approved expense for the rest of the year. The MOOP does not include the cost of prescription drugs, only medical expenses.
Although, there are many types of MAPD plans, in King County, we are limited to HMO (Health Management Organization) and PPO (Preferred Provider Organization) plans, and PACE plans. PACE (Programs of All-inclusive Care for the Elderly) is a Medicare/Medicaid program for individuals who would otherwise need a nursing home level of care, to remain in the community. We also have SNP (Special Needs Plan) plans for individuals with both Medicare and Medicaid, which we will discuss in another article. We do not have Private Fee for Service (PFFS), Point of Sale (POS), Medical Savings Account (MSA) or Cost Plans .
Many of the available plans have a zero dollar premium; many have monthly premiums. Some plans have a medical deductible which must be paid before the plan’s payment share begins; most do not. Many plans have a prescription drug deductible.
With HMO plans, individuals must use doctors and facilities in the HMO network, or pay total costs for out-of-network. If necessary, the primary care physician may apply for an exception to network from an HMO. With most HMO plans, a referral from the primary care provider is required to see a specialist. However, some HMO plans have waived that requirement.
With PPO plans, individuals may use services in or out of the PPO network, but usually pay more for out-of-network providers. PPO plans generally have two maximum out-of-pocket limits, one for in network, and one combined in and out of network. PPO plans do not require referrals to see specialists. However, many specialists require referrals from primary care physicians, even if the plan does not.
What are the advantages for selecting an Medicare Advantage plan?
First, premiums are much less than most Medicare Supplements and a Part D plan. Second, with MOOP, MAPDs have a yearly limit to the total cost an individual would pay should some medical catastrophe occur. Conversely, basic Medicare Part B has no limit to the 20% co-insurance an individual could be charged. However, some of the greatest advantages are with the variety of added benefits that these plans may include -- for dental, vision, hearing, transportation, health club memberships, over-the-counter supplements and medical supplies, and more. Most MAPD plans participate in an insulin savings program, which limits the cost of certain insulins to $35 a month.
If we choose to enroll in a MAPD, we should examine the range of Medicare Advantage plans available, and select the one that best fits our individual needs.
