Soooo, we refer to the Medicare product selections as a bit of the secret sauce to Medicare planning. When we say “products”, we mean the products that supplement Medicare. Remember that Medicare pays for 80% of your healthcare cost if you are enrolled in traditional Medicare.
Pull out your 2019 Medicare & You Handbook that you are given by the US government. Go to page five please. This shows you – and shows you pretty clearly – that there are TWO methods to the Medicare madness.
Let’s start with Medigap (left column of page five). Medigap are insurance policies that you take out with a private carrier. You pay a monthly premium for a plan. Right now, our favorite plan is a Plan G. Let’s say you buy that Plan G for $130.00 month. Now, for every Medicare approved charge that is paid by Medicare, your Plan G will pay the balance for you so that you are 100% covered. With Plan G, you will only have an annual $185 deductible to satisfy.
As long as a doctor or hospital accepts Medicare; you can go there with your Medigap card and your Medicare card. Are you a snowbird? If you live in Florida for 4 months out of the year, you can have a family doctor in Florida and one in Michigan. No networks, out of network issues, etc.
It’s important to walk through what’s important to you regarding your healthcare. Is choice of doctors important? Is budgeting important? Is travel within the US important? Are you OK with networks? How much are you using your healthcare? And more –
Note – you pair a Medigap policy with a Part D drug plan.
The worst part of having Medigap? You have three cards to deal with 🙂 Your Medicare card, your Medigap carrier card and your Part D prescription drug card.
The second path to Medicare coverage (again, go back to Page 5 in the handbook) is Medicare Advantage!
Now, these work a bit differently than Medigap.
You are now enrolled in Part C. Part C means that the insurance carrier that you chose to provide your Medicare Advantage plan is going to be the provider of your healthcare. You have one card that you’ll use at the doctors office, the hospital and typically at the pharmacy.
These plans range in pricing (in Michigan) from zero (yes, zero) to over $250 a month. They typically have co-pays, co-insurance and out of pocket maximums that vary from plan to plan. Be careful to read and understand what your plan requires of you.
Typically you will have networks – be sure that your doctors are in your network. If you are a snowbird, use extra caution in purchasing these plans.
Medicare Advantage plans can work well for some; but not so well for others. At Boomer Health Group, all we ask is that you understand what you are purchasing.
No one really likes to talk about these plans… but, they’re important. The statistics are so very high with incidences of cancer (especially as people live soooo long these days!) that we really do advocate purchasing a small cancer policy.
What does it cover? Anything. Work with us to get the RIGHT cancer policy as each policy and carrier has their little nuances and may pay out differently on a claim. Which policies do we like? The ones that when you get a diagnosis; the carrier pays you a flat 20k (or whatever benefit amount you choose). Simple. Done. Money to you.
Where does that money go? To anywhere you’d like. Maybe it pays for high cost oral cancer medication. Maybe it covers your hospital stay in another city should you need treatment there. Or, maybe you take your family on vacation because you are all stressed. Point being – you can do anything that you want with the dollars.
So, remember that we designed your Medicare coverage as best it can be but a cancer diagnosis can’t really be 100% planned for and designed for all aspects (such as a crazy expensive medication you are given) — so, please seriously consider these plans. The premiums are not that high for what you might get in return.
These are pretty slick! If you are a business owner or are employed with a small employer group of less than 20 people, and let’s say 2 of those people are over age 65… We can offer you a group Medicare supplement plan for the 2 that are over age 65.
Great parts? For the employer: it’s still employer paid coverage. For the employee: it’s true Medigap (a Plan F). It’s guarantee issue (no health insurability issues). Spouses can be added. They can be written with only one life insured. Etc!
Case study: We had a group recently that saved $20,000 on their group insurance premiums AND the client was able to get a knee replacement for no out of pocket costs to him. When we met the group? The employer was paying $20,000 more annually and the employee was paying $4,000 out of pocket with co-pays, deductibles and max out of pockets. Group Medicare Supplements can be a win:win.
These group Medicare plans can also be used for retiree plans. If you have a retiree plan that is costing your company $800 a month? You can reduce that by 50% and have better coverage for your retiree. Who doesn’t want the win:win.
We build in pharmacy, dental & vision as needed and required.
Call us to walk us through what works best for your situation.
So, you have a Medicare Advantage plan and you are seeing that they don’t quite cover everything?
We have something that might help out. Indemnity plans.
These plans come in all shapes and sizes. So, you’ll need to call one of our advisors to walk you through a plan that can be tailored to your world. The plans are designed to pay YOU after you incur a charge in your health plan.
Example. You have a knee replacement and didn’t quite think through the per visit charges that would happen with physical therapy. Well, we paired that Advantage plan up with an indemnity plan for you (right?) so that when you happen to have 22 sessions of physical therapy that cost $30.00 per visit? Well, your indemnity plan just happens to have a $30.00 reimbursement to you for each visit.
How smart is that! Yep – we live in the Medicare world so we can often come up with some great solutions for you.
Most of you have had dental/vision/hearing coverage for 40+ years on your group plan before heading to Medicare.
Now – as you arrive on that Medicare doorstep you learn that Medicare really doesn’t offer much coverage in those three areas. They will pay for medically necessary things such as cataracts, but Medicare wasn’t designed for cleanings, x-rays, root canals and such.
So, what do you do? Well, we’re here to tell you (1) there is nothing magical out there for coverage for these items. Meaning, you will not find a plan for $5.00 per month that will pay for $5,000 in annual benefits. *If you find one, tell us about it! (2) we do have some plans that we like and can help you enroll in those.
We like the reimbursement plans. There is a set dollar amount that you can be reimbursed per service for. We find that most 65+ folks really don’t want to find a new dentist at this stage of life. We get it! Thus, these reimbursement plans have no networks and required dentists to participate with, for example.
These plans do have waiting periods on major services such as a root canal (generally 12 months). If you have toothache, you can’t buy it on Monday and have a root canal on Friday 🙂 So, the plans do require some planning ahead.
As does the rest of your Medicare age healthcare planning! Call our advisors to coach you through the confusion.
Option 2: Enroll yourself using the links below if we’ve already discussed and now you are good to go!
Short-term care is a bit newer to many people. It tends to be a nice ‘in-between’ alternative to traditional long-term care policies.
As we talk about constantly, Medicare wasn’t and isn’t designed to offer true long-term care solutions.
Will they pay for your rehabilitation in a skilled nursing facility after a knee replacement? Yes. Will they pay for four years of an assisted living situation such as Alzheimers? No.
We find that many people arrive on Medicare’s doorstep thinking or assuming that Medicare will pay for these things. When you learn they won’t, what next?
There can be solutions, one being short-term care products. These can be customized to offer coverage for home healthcare, skilled nursing coverages – up to 360 days.
360 days might not sound like much but it can provide a family with many additional DOLLARS and additional DAYS to adjust to the caregiving world.
As with all of your healthcare planning, you should call one of our advisors to see what makes sense for you and your family.