Well Advised
The Wyoming Hospital Association and Campbell County Health have partnered
with Well Advised, a service for providing free, unbiased, no-obligation
and confidential Medicare information and resources to patients.
To determine best coverage options,
Well Advised works with patients to understand their budget, healthcare needs and preferred
providers, including hospitals. Well Advised then reviews all plan options
from all insurance providers and matches Medicare-eligible individuals
to the single best Medicare plan.
Free Educational Webinars
We're pleased to share this month's online sessions where you can learn
about important issues related to Medicare.
The Well Advised presenters will answer your questions during these events.
You may also submit questions in advance to
info@well-advised.com.
Medicare Overview
Download the
Medicare Enrollment Checklist here (PDF)
Medicare Options
Medicare has several parts to it. Briefly these are:
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Part A is insurance for hospital related care and typically there is no premium,
but a deductible of $1,452 in 2021 for each benefit period of inpatient
care, meaning any insurance does not pay for costs up to that amount.
A benefit period begins the day you are admitted and ends 60 days after
the end of any inpatient care.
-
Part B covers care from other providers such as physicians. There is a standard
monthly premium everyone pays of $148.50 (which may be higher depending
on your income) and there is also an annual deductible of $212.
-
Part D is insurance to help cover the costs of prescription medication. The premiums
and deductibles associated with Part D vary greatly depending on the plan
and private company providing it.
When someone turns 65 or enters Medicare for the first time when their
Group Health insurance from an employer comes to an end, they have to
make a significant choice that is unlike previous healthcare insurance
decisions.
First, Medicare is only about you and not about any other family member—there
are no family plans or discounts.
Second, it is less easy to change once you have opted for one of the two main
directions since there are always certain conditions to be met before
you can change.
The first of these two directions is called “Original or Traditional Medicare,” which is a “Fee-for-Service” (FFS) plan. In this plan you are able to select both physicians
and hospitals for care and Medicare will pay 80% of their bill. There
are significant deductibles involved, meaning that you pay 100% of their
fees until you meet the deductible amount. After that you are only responsible
for the remaining 20% of charges.
-
Original Medicare does not include the cost of your prescription drugs
and so you must have a private insurance plan to cover the cost. Part
D plan and
Prescription Drug Plan (PDP) are other names for this. It is important to understand that you
must have a Part D drug plan whether or not you are taking any medications—otherwise
Medicare will penalize you by increasing your premiums when you do sign
up for one.
-
Some of the 20% of the other non-drug charges you are responsible for—the
"out-of-pockets" costs—can be covered by having a separate,
private insurance called a
Medicare Supplement or Medigap policy. Medigap insurance is not allowed to cover your Drug Plan costs
nor the deductible for Part B, but is essential to cover your other out
of-pocket costs. There is no limit set for out-of-pocket costs with Original
Medicare, so Medigap insurance is essential in our view if you follow
this direction.
- The overall advantages of Original Medicare are the freedom of choice of
primary care doctor, specialist and hospital. If one is or becomes available
it is also easy to switch to a managed care plan from a FFS one. The freedom
of choice advantages are also the disadvantages of course since you need
to understand and compare these numerous choices to avoid delay or spending
unnecessary money out-of-pocket for which there is no maximum. It requires
your full involvement in managing your own health care.
- Typically, this FFS direction will cost you altogether about $150 a month
in premiums in 2021 in addition to the Part B premium that everyone pays.
The other direction is managed care—to enroll in private medical
insurance known as a
Medicare Advantage or Part C plan that usually includes a drug plan. These plans cover essentially
all of a person’s healthcare needs in a managed care model, which
means that you have a Primary Care Physician managing your health care
needs. You pay a typically small monthly premium (often zero) for both
health and drug insurance and often there is no deductible for health
but one for drug cover. When you receive care you also have co-pays, such
as a dollar amount for a physician office visit; and co-insurance, such
as a percentage of a drug cost. Similarly when you get prescribed medication
you will share in their cost as well. Unlike Original Medicare, these
plans have an annual limit to your costs, called a Maximum Out-of-Pocket,
which varies by plan.
- The advantage of Medicare Advantage plans is their integration of care,
their low cost and ease of access, and many of them offer significant
other benefits that are not available in Original Medicare.
- Their disadvantages are that they usually have a network of approved specialists
and you must get approval for referral to them should this be needed.
Network sizes are better than they used to be but are still limited.
- A further disadvantage is that it becomes difficult to move back to Original
Medicare as you age, and your specific needs or preferences change. You
may have to go through medical underwriting for instance before a Medigap
plan will accept you and the plan can deny you coverage or increase your
premiums at will.
- Many of these Medicare HMO plans will cost zero premiums a month in addition
to the Part B premium that everyone pays.