SECTION 1

Question : Could you come up with an additional $100 to $160 a month for a Supplement Plan

(AKA Medigap)?  

[[If no – Skip to Section 2 below.]]]

If can swing the money then read this:
It’s an additional amount because it is in addition to the $170 you will pay the government for Part B. If you are able to come up with that amount, but aren’t sure if you want to, then you have to decide if the best plan possible is worth the extra $100 to $160 monthly.

Or, if you are healthy, and hope to not go to the doctor very much; you could save money by getting a low to no-cost Advantage Plan (usually an HMO).

A Supplement is like a PPO, but better, because there is no network, you go wherever you want. If you have health issues and have a lot of doctor visits to specialists, you’ll be better off with a Supplement plan instead of an HMO or other Advantage Plan. A typical Supplement Plan has very low out of pocket costs for any medical services rendered.

To compensate for less flexibility and in some cases higher out of pocket costs for medical services, many Advantage HMO Plans offer extras like free rides to the doctor, free dental and vision, flex spending cards, Part B premium giveback* etc. *

Part B Premium Giveback is where the insurance will pay a certain amount of your part B monthly premium for you.

Basically, they make so much money from contracting with the government to manage your Medicare that they can often not only offer you coverage at no monthly premium, but can in fact also pay part of Your Part B monthly cost.

It’s either pay more for a Supplement with greater flexibility and no managed care, and go where you want; or get a low to no-monthly-cost HMO with extras thrown in. Some HMOs have a maximum out-of-pocket possible annual cost for services rendered as low as $699 and others as high as $6,700. It varies by location.

HMO Monthly premiums are often zero, but may also be in the $20 to $65 a month range. I will always recommend the Supplement if you can afford it. But reality is reality, and if you’d rather save the monthly cost; then go for the HMO. It’s your choice. In most places in AZ, CA and NV, the HMO is zero premium cost per month.

Note: You can usually switch later on but it is harder to switch from an HMO to a supplement than the other way around.

SECTION 2

No, I can’t afford an additional $100 to $160 a month for a Supplement (Medigap Plan)

An Advantage Plan is the realistic answer. In most cases this will be an HMO, although in some areas it can be a PPO. Monthly premiums for an Advantage Plan are usually zero.

SECTION 3

Do you have Medicaid or MediCAL?

If yes, you most likely do not qualify for a Medicare Supplement (AKA Medigap plan).

There are still two ways you can go. 1.     You can either Get A and B and let the state arbitrarily pick a drug plan for you, and then your Medicaid or MediCAL will pick up the other costs that A and B don’t. (Note: if you have full Medicaid or MediCAL, the government will also cover the cost of your Part B monthly premium, so no worries there. 2.     Or, you can choose an Advantage Plan, for zero to low cost (usually, but not always, an HMO). Medicaid or MediCAL should pay for the cost, if any, of the plan. Any copays or coinsurance of this plan should also be paid by Medicaid or MediCAL if you are a full participant.   What this second option does for you is give you extra benefits that you may not otherwise get, like free rides to the doctor, free dental and vision, flex spending cards, free gym membership, and much more. Most people choose the second option. However, there are times when the first option is the best. For example if a person has a lot of specialists they see and those specialists are not in the same medical group, then they may be better off in option 1. If you are interested in option 2, then call Lee Martinson at (909) 790-8622 to see what is available for you.