Medicare QuestionsThe Medicare Open Enrollment period is not far away. It begins on October 15th and runs through December 7th.  This is always a time of great confusion for seniors who are trying to understand their options and get the best coverage for their situation.  Unfortunately, many people don’t know who to turn to and there is a lot of misinformation out there.  Sadly, the people who want to help you the most, family and friends, don’t have a solid understanding of Medicare and don’t have the knowledge to give advice and answer your questions accurately.

You can always to turn to the professionals at Dave Silver Insurance. We can walk you through the process and answer all of your Medicare questions. We guarantee we can locate you your best options, based on your individual needs.  We have been doing this successfully, for many years.

Below are some of the important questions that you should be asking. I will include the answers, as well.

1)How much is the premium?

If you go with a Medicare supplement the premium is generally based on your age. Medicare premiums vary based on where you reside. For example, supplements are less expensive in Tampa than they are in West Palm Beach.

Many Medicare Advantage plans in Florida have no premium, but some do.

2) Do I need to select a Primary Care Doctor?

If your plan is an HMO, you will need to select a PCP. Under an HMO your primary care doctor will coordinate your care and provide the referrals needed to see Specialist.

If you select a PPO, you may not need to select primary care doctor.

3)Does my plan have a deductible? 

Medicare Advantage Plans do not have deductibles for the medical part of the coverage. Some Medicare Advantage plan deductibles for prescriptions for higher tier medications. Generally, around $250 per year.

Some Medicare supplements will have deductibles, based on the plan letter. For example, a low premium Medicare supplement option is a “high deductible” Plan F. Under this plan you will have a deductible of $2180 before you are covered at 100%.

4)What are the co pays?

Co-pays are what you are responsible for when you receive care. Under Medicare Advantage you will have different co-pays based on the services provided.  For example, you may have a $30 co-pay to see a specialist or you may have a $200 co-pay per day in the hospital for the first 5 days.  Different MAPD plans have different co-pays. You can compare co-pays from different plans by looking at each plan’s summary of benefits.

Co-pays for medication work the same way. It’s your portion of the cost. If you take a medication like Crestor, for example, the co-pay under one plan might be $45 per month, but under a different plan it might double that amount. Also, the higher the tier, the higher the co pay. Prescription co pays will vary from plan to plan, as well.

Make sure to compare co-pays for prescriptions when making plan selections. This needs to be part of the equation.

5) Am I covered for emergency care?

Whether you have a Medicare supplement or a Medicare Advantage plan, you will be covered in an emergency, in all 50 states and US territories.   Some MAPD plans and some Medicare supplements will cover you for emergency care in a foreign country, as well.  This is important to keep in my mind if you like to travel outside the country.

6) Under Medicare Advantage, what does “maximum out of pocket” mean?

Maximum out of pocket means the amount you will have to pay in co-pays or coinsurance in a calendar year, under a specific Medicare Advantage.  Maximum out of pocket, also referred to as MOOP, puts a ceiling on how much you would have to spend each year on your healthcare costs, per year. This number does not include prescription medication. That is separate.

For example, if you select a MAPD plan that has a $3400 MOOP.  Let’s say you see a specialist under the plan, and the copay is $50. This will drop your MOOP to $3350. If your MOOP should drop to $0, you won’t have to pay for any care for the balance of the year.  MOOP is there for your protection.

7) What are the main differences between and HMO and a PPO?

HMO coverage:

You need to select a primary care doctor

You need referrals to see Specialist

You are generally covered “in-network “only, unless it’s an emergency

Often time you will receive lower co pays and richer benefits under this type of coverage

PPO coverage:

You do not need referrals to see specialist

You are covered both “in and out-of-network” (out of network will cost more)

Generally, you will have a larger network of providers

Generally, co-pays are higher than an HMO

Generally, benefits are not quite as rich as HMO benefits

Have additional Medicare questions?