by Barbara Nevins Taylor
Joe Namath was a great football player and George Foreman a great boxer. Their athletic prowess doesn’t necessarily make them experts on Medicare, yet you can feel the appeal as they insistently push insurance companies’ Medicare Advantage plans on cable TV. This is the time to review your Medicare plan and your Medicare Part D drug plan, but the advice of celebrities on TV might not be the best. That’s why it’s a good idea to review the Medicare and drug plans you have now to see if you need to make a change. You have until December 7, 2021 to make changes that will go into effect on January 1, 2022.
Medicare Advantage plans may be great. They do offer extra benefits that may include gym memberships, some vision, some dental care and some over-the-counter medication. Most also include a drug plan so that you won’t need a separate Part D plan.
Medicare pays the insurance companies and they have to follow rules set by Medicare. But they can also charge different out-of-pocket costs and set their own rules for doctors’ referrals and referrals to other providers.
That’s the sticky part.
You likely will have to use doctors, healthcare facilities and physical therapists in their network. If you find all of your healthcare providers on the insurer’s list, then Medicare Advantage might be the way to go for you.
But, and this is a big but, if your doctors, medical centers, physical therapists and others are not on the list, you might want to seriously think about choosing a Medigap supplemental program. These programs cover the 20 percent portion of your bill that Medicare doesn’t pay.
A couple we’ll call Pete and Pat joined Medicare in 2014 and 2019. Medicare Advantage worked for them until Pat fell and broke her knee and injured her hand. The specialists she needed were not available in the Medicare Advantage plan they had. “We didn’t realize how limited it would be until we had a problem,” Pete said.
Just a quick overview here. Original Medicare Part A helps pay for hospitalization and inpatient care. Part B helps pay for doctor visits and outpatient care. When you enroll in Medicare you get part A automatically. Then you can opt in for part B. Then you want a plan to cover what Medicare doesn’t pay.
That’s where Medigap or Medicare Supplemental Insurance Plans come in.
Because Pete and Pat joined Medicare before January 1, 2020, they are eligible for a supplemental plan in the Medicare Part F category. They’ll each pay a monthly fee that is likely to be a little over $300. It will cover the Medicare Part B deductible and hospitalization up to 365 days and skilled nursing for 100 days. It will also cover doctor visits and outpatient care without co-pays and it will pay for lab tests.
Congress didn’t like Part F because it didn’t require Medicare recipients to pay for Part B out-of-pocket costs or Part B deductibles. So it did away with it. Your representatives in Washington apparently thought this would control medical costs.
If you joined Medicare after January 1, 2020, the closest option is a Medicare Plan G.
Take a close look at what you have, and what you need. You have only until December 7, 2021 to make change your plan for 2022.
Also take a look at your Part D drug plan to make sure that it covers the medications that you use. Insurers change their offerings, what they call their formulary, every year. So you want to take care to ensure that you are covered.
Forget the ads and the first things you see on Google. Try Medicare.gov and compare plans.
