Medicare Enrollment 2018

You can stop holding your breath because the best time of the year will be here soon. I am referring to Fall. The changing of the weather and the beautiful fall foliage. It almost like you can feel the season changing. Let’s not forget Football and all of the emotions that come with watching your favorite team compete while you and friends BBQ and share a moment together. Then comes Halloween with all the kiddos out walking through the neighborhood honoring that tradition of “Trick or Treat”…not sure if I have ever seen someone play a trick. Last but definitely not least, that Thursday where everyone gets together and stuffs their bellies until they are about to explode, Thanksgiving. There is never a better time to bring families closer together to love, laugh, and cook a big meal.

But I regress, because this time of year is one of the busiest for Independent Medicare Specialist like myself. October 15th through December 7th is the holy grail in our business. This is the one time every year that the 57 million people on Medicare come alive to see what is out there to be had. Who has the best benefits? Who has the lowest cost? Are my drugs still covered in the plan I have? Should I stay where I am at and comfortable with or should I jump into the unknown and change plans?

All great questions, and your mailbox will fill up with brochures from companies touting their product being the best with all the bells and whistles. Then every other commercial you see will be about Medicare and last but not least are the full page newspaper ads. So how do you sort it all out? It all looks good like one of those high end buffets you go to at a Casino. So much to eat, but there is only one you and you get one choice to get it right.

What are the options and why do you only get 7 weeks to make changes? Well, you actually might have other times to enroll or change, but you don’t know it. You see Annual Enrollment Period October 15th through December 7th really only applies to people who are on a Medicare Advantage Plan or Prescription Drug Plan. So if you have just Original Medicare with a Prescription Drug Plan, but you want to change to a Medicare Advantage with the drugs included, this is your opportunity. If you are on a Medicare Advantage and want to go back to Original Medicare with a Prescription Drug Plan this is the time to do it. This is also the time that you can switch to a Medicare Supplement Plan if you have been on a Medicare Advantage Plan and you are medically qualified. Medicare Supplements usually require medical underwriting past 65, but Medicare Advantage Plans do not.

I will not go into the other enrollment times here because this article is about enrolling for your 2018 benefits. If you want to know about other enrollment periods go to my YouTube Channel MarkGarrettMedigap where I cover all enrollment periods.

So what plan options should you be looking for in a plan? Well if you go the Medicare Advantage Plan with Prescription Drug Coverage you need to be aware if it is an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Both types of plan HMO and PPO have networks that you are forced to use or encouraged with PPO’s. HMO’s usually make you choose a primary care physician (PCP) and they are the ones that have to give you referrals to other physicians and for testing. PCP’s act as gatekeepers for the Insurance Companies. PPO’s allow you to choose any physician, but you will pay more if you see an out of network physician. With that being said you are responsible for finding out if all of your physicians are in network. You are also responsible for finding out if your drugs are covered. All companies that sell Medicare Advantage Plans are private companies who have their own formulary. Medicare has a large Formulary, but the Insurance Companies only have to offer a portion of those medications, usually one to two medications that treat each of the categories of health issues.

So with all of that overwhelming issue out there how do I decide? Well I always suggest talking to an Independent Broker. (Disclaimer, I am an Independent Broker), I would never suggest a small business owner do their own taxes. I use an Accountant every year. I would not recommend anyone to represent themselves in a big lawsuit, that is why we have Attorneys. That is why people like myself, and there are many of us, specialize in one type of Insurance Line, Medicare and products related to Medicare Clients. But, if you need to strike out on your own I am including two links. The first is the Medicare Find Plans and Find A Doctor or Facility.

I will be the first one to admit that there is no better tool available for finding a Prescription Drug Plan than Medicare Plan Finder. You enter your zip code, your medications, and your pharmacies and it spits back out 20+ plans in order of the most cost effective based on your medications. I personally use it all the time when I am meeting with clients.

The last thing I will mention is if you have the health to qualify, you have to look at Medicare Supplements. Why you ask? Well I am going to drop the curtain and let you in on a secret, Independent Brokers, Captive Agents, anyone selling Medicare very likely makes less money selling a new Medicare Supplement Plan than a Medicare Advantage. By the way, you the consumer do not pay us the Insurance Company does. They would love nothing more that you to call them directly and enroll. Then they wouldn’t have to pay a commission to anyone. So why is it that so many Medicare Specialist are trying to persuade you to get a Supplement? Because, if you were a doctor and had two treatments to give a patient, one you would get paid more for or one that was a more effective treatment, what would you do? I hope the right thing.

You see Medicare Supplements are a superior product. They allow you to go to any Doctor or Facility in the United States that accepts Medicare. Medigap Plans (Medicare Supplements)do just what the name implies, they fill the gap between what Medicare pays and what would be left to you out of pocket. If my own family needed a product this is what I would put them in.

So, for those hardcore numbers people out there I will make it simple. Let’s say you are on a Medigap Plan F and pay $150/month or $1800 per year, and no matter what happened to you that year, open heart surgery, two hip replacements and a bout of Pneumonia, you would only pay that $1800. Medicare and the Medigap Plan would pay the rest. Now let’s look at a Medicare Advantage Plan that has no monthly premium. Based on the above scenario you would be in the hospital 4 times with a copay of$1200-$1600 for each stay. Then you would have to pay co-payments for surgery, doctors visits, and therapy. You could be on the hook for a max of $7200 that Medicare allows the company to make you pay and that is a lot more than the $1800.

But, I do need to talk about the good points of an Advantage Plan. For people on tight budgets, or people who also have Medicaid and get help from the Government, Medicare Advantage Plans fill their need. Actually, in very large cities with large networks of physicians Medicare Advantage might be just the ticket. After all, MA plans come with Prescription coverage, usually dental (X-rays and two cleanings), vision (eye check and glasses), and sometimes a gym membership.

So whatever you do, enjoy the return of Fall. The weather cools off and there are plenty of things to do. I have given you great tools to make your health decisions. Don’t get stressed out by all of the options. If you need more advice you can always call me, Mark Garrett, at 800–708–5810. Stop by my website and check out all of the free resources I provide under the education section. Go to the thank you link to get some cool giveaways.