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.

• October 4: Top 5 Solutions to Common Medicare Mistakes
• October 12: Medicare Open Enrollment
• October 25: Medicare 101

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:

• 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.