Do you need help understanding which medicare plan to choose?
If you are feeling overwhelmed, we understand how you feel and we are here to help you obtain the needed medicare insurance plan that is designed to meet your individual needs. As an independent Insurance Agent and Broker, we represent all of the major medicare insurance carriers, which allows us to have an unbiased opinion on which carrier and plan would work best for you. Our Insurance Agents are certified through a national organization called America’s Health Insurance Plan (AHIP) Certification which requires a 90% or higher grade to pass each year.
All of the medicare insurance carriers pay us the exact same amount (in the form of a commission) no matter which plans we point you to. This means that by using Integrity Now Insurance Brokers it will not cost you a penny because we are paid directly from the insurance carriers, so it is a win for you.
For most people in the Los Angeles, CA area a medicare advantage plan is a very good option as Los Angles county has one of the most plan options (as compared to other States and Counties) including dozens of plans with no additional monthly premiums.
Areas that are more rural or a smaller county, it may be a better option (or their only option) to select a medicare supplement plan. Or you may want to want to not be restricted by which Doctor you can go to because they are out of network.
You might be asking yourself, do I pick a Medicare Supplement or a Medicare Advantage Plan. What are all of the different plans and do they all cover me the same? Do each of these medicare plans cost money or do they charge no additional premium. Is there an advantage to picking one type of plan over another? Let’s start to explore some of these questions and more below.
Common Questions we hear from our Client
We receive lots of questions from our clients. Below are a few of the most common ones we hear:
- My friends say that our area has over a 100 different Medicare Advantage plan options and I have no idea which one would best serve me?
- Should I buy a Medicare Advantage plan or a Supplement plan?
- Should I choose a Medicare Advantage plan?
- How do I sign up for a Medicare Part A, Part B?
- I have Diabetes, and/or a heart condition is there a special plan for me?
- Will all Part D plans cover all of my drugs / medication?
- Can I have a plan that includes gym membership at no cost?
- What is the difference between the drug coverage under medicare Part B and Part D prescription drug coverage?
- What is the difference between an HMO and a PPO Medicare Advantage Plan?
- Why do some Medicare Advantage Plans cost additional money and others don’t? Is one better than the other?
- I want a Medicare Supplemental Plan which one should I pick?
There are 100 Different Medicare Advantage Plan Options which one do I pick?
When looking at medicare advantage plan options, picking a plan is not as easy as zeroing in on the plan that has a zero dollar premium. Each medicare advantage plan and Insurance Carrier offer different coverage options and these options can change each year.
For instance you might have a specific drug that you need and Insurance Carrier A will cover that drug but they put it under a higher Tier Classification which will end up costing your more money each time you purchase that specific drug. Where Carrier B puts that same exact drug at their lowest tier which could save you a lot of money.
I recently compared several insurance carriers. Each of these insurance carriers had a zero dollar monthly premium and these carriers had a very low max out pocket limit of $1,000. On the surface these carrier look like they are identical. For this analysis let’s call these insurance companies Carrier A & Carrier B.
As we dig deeper into your needs, lets say you were in need of hearing aids. Hearing aids fall outside of the Medical max out of pocket as this is an ancillary coverage. Carrier A has a co-pay of $699 per hearing aid and Carrier B has a zero dollar co-pay but limits their cost to a max benefit amount of $3,000. The average price of a hearing aid is $2,300. So based on this Carrier A would cost you $1,398 ($699 x 2) and carrier B would cost you $1,600 ($2,300 x 2 = $4,600 minus $3,000 Max Benefit Amount = $1,600).
After this review we can see that Carrier A would save you $202. While this may not be a significant savings it is your true cost if we assume you can purchase the hearing aids at the average cost.
Should I buy a Medicare Advantage Plan or a Medicare Supplement?
The answer to this question is never simple. My simple answer is: It depends on several factors.
Some of these factors include:
- What county do you live in
- What Zip code are you located in
- Can you afford to pay extra on top of your Part B premium
- Do your medicare advantage plans cost more than a medicare supplement in your service area
- Is there a limited number or no medicare advantage plan in your service area
- Do you insist on going direct to a specialist without a referral
- You don’t want surprises or major plan changes as can be common in a medicare advantage plan
- How healthy you are
- Can you pass medical underwriting for a Medicare Supplement if you don’t qualify for a guarantee issue option
- Do medicare advantage plans offer more benefits at little to no additional premium
Why Choose a Medicare Advantage Plan?
Integrity Now Insurance Brokers is located in Long Beach California and in this area (Los Angeles County) we have some of the richest medicare advantage insurance plans (meaning lots of coverage for minimal cost) in the country. For this area and many of the areas surrounding Los Angeles County picking a medicare advantage plan is a great option.
Following are reason to pick a Medicare Advantage Plan (“MA-PD”):
- MA-PD plans typically include your Part D (Prescription Drug Coverage)
- MA-PD must provide a minimum of the Federal requirements but usually offers additional benefits beyond the minimum Federal requirements.
- No cost gym membership (AKA: Silver Sneakers)
- Free rides to your doctors office and/or local gym (Maximum Limits and distance may apply)
- Plans may include zero dollar copy to your Primary Care, Specialist, Hospitalizations, Out-Patient Surgery and other items.
- No or very low Deductible options
- Max Out of Pocket cost as low as $1,000 for your medical expenses
- Option to reduce your Part B Premium by $52,10 per month (2019 Plan Year)
- Dental Coverage
- Vision Coverage
- Chiropractic Coverage
- Over-the-counter medication benefits
How do I sign up for Medicare Part A and/or Medicare Part B?
- Go online to the Social Security website at https://www.ssa.gov/planners/retire/applying8.html
- Call the Social Security office at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7AM to 7PM.
- In-person at your local Social Security office.
Is there a special plan for people with Diabetes or have a diagnosed heart condition?
This is a great question. Yes, some medicare advantage carriers offer plans tailed for individuals that have a specific need called Special Need Plans (“SNP”).
Each of these plans are tailored to meet your specific need. Some of the most common SNP plans include the following
- An institutionalized individual (I-SNP),
- A dual eligible (enrolled in Medicare and Medicaid), (D-SNP) or
- An individual with a severe or disabling chronic condition (C-SNP), as specified by CMS.
Depending on your situation a traditional medicare advantage plan may not be your best option. If you qualify for any of the above SNP plan options these could be a better option for you.
Will all Part D plans coverage my medications?
As part of your plan review that we will conduct we will ask you for a list of all medications you are currently taking.
We do this because not all Part D or Medicare Advantage plans that offer Part D cover all medications that you might be taking.
If you are on a medication that is not covered by any plan you or your doctor can submit a drug exception if there are no alternatives to that specific drug or if you have already tried a different drug and it did not work. It is important to mention that this exceptions must be submitted and approve each plan year.
Is Gym membership / SilverSneakers included in the plan at no additional cost?
Most medicare advantage plans include gym membership for you at no additional cost. Many carriers do participate in a program called SilverSneakers which is a fitness program that allows seniors the opportunity to workout at a local gym.
Some carriers may charge for their gym membership but it is important to note that those that do charge may have included some additional benefits that go beyond the traditional no cost gym membership option.
Some medicare supplemental plans are now offering gym membership in their plans as well. This is a new additional so if you are wanting this to be included in your supplemental plan this could now be an option for you.
What is the difference between drug coverage under Part D and Part B coverage?
Part D covers your prescription drug that you obtain at a local pharmacy. It is important that you pick a pharmacy that is consider an in-network pharmacy to ensure your prescriptions will be covered under your Part D plan.
Some carriers have a preferred pharmacy option verses a standard pharmacy option. If you go to the preferred pharmacy this will allow you to take advantage of all of the savings.
Part B drug cover are usually those drugs that you would not give to yourself at home.
Here are some examples of potential drugs that would fall under Part B:
- Drugs used with an item of durable medical equipment (DME)
- Some antigens
- Injectable osteoporosis drugs
- Erythropoiesis-stimulating agents
- Blood clotting factors:
- Injectable and infused drugs:
- Oral End-Stage Renal Disease (ESRD) drugs:
What is the difference between an HMO and a PPO Plan?
Just like the health insurance you had prior to obtain access to Medicare, an HMO and PPO function is the same way.
Under an HMO your are required to have a Primary Care Physician. The Doctor must provide you with a referral in order to see a specialist. There are some plans under Medicare that allow for self referral on a limited basis. You are also required to only see Doctors who are in-network or your will be required to pay the full cost of the visit if you go to someone who is not in your network.
In the event of an emergency you are allowed to go to a hospital that is not under the HMO network. Once you are stable you may be transferred to a hospital that is under the plans network.
PPO plans allow you to self referral out to see a specialist and it allows you to go to a Doctor who is not under the PPO network and still have coverage under the plan. It is important to mention that if you go to a Doctor who is not under the carriers PPO network you may have to pay a higher cost for that visit.
We recommend that you do your best to stay in the carriers network to ensure you don’t pay more than you should be paying.
Why do some Medicare Advantage plans charge zero and other charge hundreds of dollars each month? Is one better than the other?
Another great question. When it comes to Medicare Advantage plans not all plans are equal. But that doesn’t mean paying a monthly premium equals better coverage.
For some carriers they may restrict the network size in the free plans and increase the network size in the plans that cost money.
This is where we come in to do a plan review so we can help guide you to the carrier and plan that is providing you with everything that you need.
Most of the time a plan that does not charge an additional monthly fee is more than sufficient to meet all of your needs.
Which Medicare Supplement Plan is best for me?
Many Insurance Agents will point their clients to a supplemental Plan called Plan F. This plan provides the most comprehensive coverage. With that coverage comes a higher monthly premium.
Following is an example of rates for a 65 year old.
Plan F – Monthly Premium $160 (No Deductible) (No longer Available in 2020)
Plan G – Monthly Premium $142.41 (Part B deductible required $185 per year)
Plan N – Monthly Premium $122 (Deductible Required and Extra Charges)
We would typically recommend Plan N and here are the reasons.
- In a 12 month period you will save $456 over the Plan F
- 90% plus of all Doctors take Medicare Assignment and won’t charge the Extra Charges of 15% of the total bill.
- Most if not all of your Doctors will not charge the Extra Charge so why pay the extra premium.