Reaching retirement age is glorious, right? No more daily work grind, more time to spend with grandchildren, discounts at restaurants and attractions and last, but in no way least, Medicare benefits.
But navigating the Medicare path can be tricky and confusing. And decisions come with a deadline. This year’s annual enrollment period closes December 7.
Matt Smith, Spectrum Health director of corporate payer relations, said Medicare Advantage is an alternative option to bolster original Medicare (Parts A and B), which is administered through private health insurance companies.
Medicare Advantage and Medigap plans help cover the costs not covered by original Medicare.
Medicare Advantage plans can be more affordable and offer better benefits, according to Smith.
“I would definitely encourage people to consider Medicare Advantage,” Smith said.
Additional benefits can include predictable co-pays and deductibles, access to wellness and chronic condition programs, gym memberships, dental and prescription drug benefits.
“You will have better benefits than you would get under original Medicare,” Smith said.
“Essentially, Medicare Advantage is a program whereby the federal government contracts with insurance companies like Priority Health,” Smith said. “This gives Medicare beneficiaries access to the outstanding customer service, health and wellness programs and extensive provider networks.”
Smith said for 2017, Priority Health is offering Medicare Advantage plans with monthly premiums ranging from $0 to $132. As a rule of thumb, the higher the premium, the lower the out-of-pocket costs.
“The individual would still pay their Part B premium of $134 a month to the federal government,” Smith said. “They would still pay that, but could opt for a $0 Priority Health plan that would even give them a $5 rebate on their Part B premium and they’d have better benefits than they would get from original Medicare.”
Smith advises when selecting a Medicare Advantage plan, to make sure that the doctor and hospital you want to use are in the network, and don’t forget to consider your needs if you are a snowbird and spend the winter in Florida or Arizona. Priority Health Medicare Advantage plans will cover emergency and urgent care services worldwide. If you are admitted to the hospital due to your visit to the emergency room, you will be covered the same as if you were at home.
It’s also important to consider your personal health status. Are you healthy with no real issues, or do you have a chronic condition such as diabetes or heart failure? By determining the type of care you require, it will help you choose the right plan. If your health picture changes during the year, you can change your plan at the next annual enrollment period from October 15 through December 7.
“Understanding the total costs you will pay out of pocket with any given Medicare Advantage Plan in relation to the total benefits is unique to each person’s situation, but also know that Medicare Advantage plans have a maximum you will have to pay out of your own pocket and then the plan covers 100 percent. Priority Health has many experts available to help walk people through plan options.”
Another benefit to Medicare Advantage is many plans also include prescription drug coverage along with medical coverage in a single plan. New to Priority Health’s Medicare Advantage plans this year is a preferred pharmacy program.
“If you go to a preferred pharmacy, which includes many of the local and national chains such as Walmart, Walgreen’s, Costco, Meijer, Spartan and a ton of other options, you will pay $5 less for your prescription in tiers one through four,” Smith said. “It’s an excellent value.”
If you are not sold on Medicare Advantage, Smith said Medigap is another option.
“Medigap is a supplemental product that covers costs that original Medicare doesn’t cover,” he said. “It’s been around for a long time. Medigap is usually a higher monthly premium, but you pay less or nothing for covered services. Medigap plans are accepted by any provider that participates in Medicare.”
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