Bombarded by Medicare information? Here are the basics

By Kathy Feist

On every television, radio and publication, there are ads selling seniors the newest Medicare Advantage plans. That’s because the period from October 15 to December 7, known as Fall Open Enrollment, is an opportunity for those 65 and older to change plans that might save them money or provide more benefits. 

Each year Medicare users can expect their premiums and deductibles to increase or decrease. This year Original Medicare plans increased deductibles for hospitalization (Plan A) and doctor visits (Plan B) and monthly premiums for Plan B and prescription plans (Supplemental Part D). 

Medicare users should receive notice of the increases. 

Although Fall Open Enrollment is primarily for Medicare Advantage and Supplemental Part D prescription plans, it’s still a good time to revisit all Medicare options with an expert who can  explain in simple terms which is best for your lifestyle, health and budget. 

Where to start

Medicare applicants have six months to apply for Medicare when they turn 65: three months before and three months after their birthday. They can receive the Original Medicare plan (Plans A and B) by simply contacting Social Security, not Medicare, or meeting with a provider. 

Original Medicare covers roughly 80 percent of hospitalization and doctor’s visits. It does not include prescription coverage, dental, hearing, etc. 

Medicare is always the primary insurance. But there are numerous Medicare insurance plans sold by private companies to fill in the gaps left by Original Medicare. 

“The Kansas City metro area has excellent options,” says Ron Gordon, an independent licensed insurance agent who also specializes as a Medicare advisor. “There are 35 to 40 different Medicare Advantage options. It’s important to look at them to find what fits you best.”

Medicare Supplement and Medicare Part D

Medicare Supplements (also called MediGaps) are not part of Medicare. They are stand-alone insurance policies provided by private insurance companies. 

Medicare Supplement plans can cover some or all remaining out-of-pocket costs not covered by Original Medicare. 

Pam Stille, a Medicare expert with Polaris Insurance Solutions, recalls when her mother battled a brain tumor for two years and died at the age of 68. “Her Medicare supplement plan paid for everything,” she says. “We didn’t have to pay one penny.”

There are 10 supplement plans that seniors can choose from. Stille’s mother had Plan F which is no longer available; however, Plan G is a similar plan and currently the most popular.

Another advantage to having Medicare Supplement policies is that they cover travel abroad and have no doctor referral or network restrictions.  With most Supplement plans seniors can go where they want, when they want without facing significant out-of-pocket expense. 

Supplement plans–with the exception of the Prescription Plan Part D– also can be changed at any time of the year and do not rely on the Fall Open Enrollment period. (Part D can only be changed during the Fall Open Enrollment period.)

Medicare Advantage Plans

Then there is the Medicare Advantage Plan (Part C), which the government allows private parties such as PPOs and HMOs to sell. 

Medicare Advantage Plans cover what Original Medicare does not, such as:  

• Routine hearing, including hearing aids
• Routine dental care
• Prescription drugs and some over the counter medications
• Silver Sneakers Fitness classes and gym memberships
• Meal delivery to your home
• Transportation to doctor visits
• Hospice

Medicare Advantage premiums are usually less expensive, sometimes advertising a $0 monthly premium. However, paying no monthly premiums may mean higher deductibles and copays. 

Advantage plans also rely on participating networks of doctors, hospitals, and medical facilities. This can be a problem if you need care outside of the network. 

Medicare Advantage is attractive to seniors who can’t afford monthly premiums and for the most part are healthy and do not need medical care.