4 OPTIONS FOR MEDICARE BENEFITS
Your Medicare Benefits Options and Their Risk Profiles:
Understanding your options for Medicare benefits is important because Medicare plans have different benefits, risk levels and costs. One plan gives you substantial risk while the others transfer risks to an insurance company in exchange for a premium. These plans are available to you once you’re entitled to and/or enrolled in Medicare Parts A and B (Basic Medicare).
After you have your Medicare options, there are just three more easy steps left on your path to Medicare. First, you connect with Social Security; second, with your unique circumstances and preferences in mind, we research; third, we present your different coverage options and help you enroll in your chosen plan. We are on your side each step of the way and each year that follows, helping you understand your options and select appropriate coverage. Griset Medicare Solutions is your trusted, licensed, independent agent.
BASIC (“ORIGINAL”) MEDICARE OPTION
This plan provides you with a combination of in-patient hospital (Part A) and out-patient (Part B) medical benefits. In each benefit area there are deductibles and co-insurance that change annually and can require out-of-pocket costs with no limits. These costs represent what you will have to pay if you are “self-insuring” against potentially devastating medical expenses.
Since most providers of medical services accept Medicare, this kind of plan operates like a fee-for-service plan where you can access care throughout the United States.
Most Medicare participants (known as “beneficiaries”) receive Part A benefits without paying a premium; Part B benefits, however, require a monthly premium (in 2021 it begins at $148.50). This premium, however, can increase in relation to a participant’s higher income level. Follow this link to see Basic Medicare’s benefits and costs: https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
In addition to having substantial financial risks, the Basic Plan does not include any drug benefits. As a result, most seniors add a prescription drug plan (called Part D of Medicare) to minimize the risks of medication expenses. For more information follow this link https://www.medicare.gov/Pubs/pdf/11579-medicare-costs.pdf
MEDICARE SUPPLEMENT (“MEDIGAP”)
This plan is a way to transfer the major out-of-pocket costs of Basic Medicare to an insurance company. Like Basic Medicare, it allows you to get fee-for-service medical care from any provider who accepts Medicare.
This kind of plan “wraps around” Basic Medicare benefits and can eliminate your requirement to pay various deductibles and co-insurance. In 2021 the annual deductible for Medicare Part B beneficiaries is $203, an increase of $5 from the Part B deductible in 2020.
Medicare has authorized 10 different Medicare Supplement plan designs that are identical in every state. Insurance companies sell these plans and establish premiums by geographic markets. The 10 plan designs are summarized in this graphic: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
Choosing a Medicare Supplement plan when you are first eligible for Medicare benefits guarantees you coverage as long as you pay the policy premiums set by the company. However, if you select coverage after you are first eligible or at some other time, you may be subject to the insurance company’s medical underwriting, which includes an extensive look into your medical history. At this point, the company can deny coverage or set higher premiums based on your medical history and pre-existing conditions.
Some companies also offer benefits that go beyond Basic Medicare by adding vision, hearing, and gym/health club membership benefits to their coverages.
Most individuals who choose a Medicare Supplement when they are first eligible add a prescription drug plan (called Part D of Medicare) to minimize risks when paying for maintenance and other medications.Click here for more information on Part D.
These plans (known as Part C in Medicare) include all the coverages of Basic Medicare and much more. These plans frequently include drug benefits, eliminating the need to purchase a separate Prescription Drug Plan (Part D). Even better, in certain geographical areas these comprehensive healthcare plans are available without a premium. (You do continue to pay any Medicare A and B premiums, however. )
In contrast, to Medicare Supplement plans, Medicare Advantage Plans are managed care plans like HMOs. A medical group of primary care and specialty physicians provide care, along with related acute care hospital coverage. Seniors who choose a managed care plan usually do so for convenience, low out-of-pocket costs and the providers’ reputation for quality care.
In addition to coordinated care, Medicare Advantage plans deliver a wide array of benefits that go beyond Basic Medicare or Supplement plans. These added benefits can include:
- Personal Emergency Response Systems
- In-Home Meal Delivery
- Hearing Aids
- Gym Membership
- RN Hotline
- Over The Counter Medicine
- Home Care
With Medicare Advantage you can minimize your out-of-pocket expenses and avoid the costs that come with Basic Medicare or Medicare Supplement coverage.
This coverage can be added to Basic Medicare or a Supplement Plan. The timeliness of your purchase, however, is important: missing an enrollment deadline for this coverage can result in a premium penalty you will pay for all future years.
In order to assist in your selection of a Part D drug plan, Griset Medicare Solutions includes a listing of your routine medications in its research of ALL the available Medicare drug plans in your area. This expert research brings you the most cost-effective drug plan to go along with your other coverages.
The premiums you pay for this drug coverage transfer the risks of substantial future drug expenses to an insurance company.
If you’ve chosen a Medicare Advantage plan with drug benefits, you won’t need to purchase a separate drug plan.
This link explains a Part D plan premium adjustment related to income: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/PartDIRMAA2020.pdf