Seniors and Medicare
Almost all seniors when they turn 65 and are thinking about going on Medicare are usually confused about what direction to go. Do I just get Original Medicare and a standalone drug plan, or get a Medicare Advantage plan or buy a supplement and standalone drug plan? Too many choices and not enough answers. Each insurance company employs agents to sell their products but not a competitor’s plan. That is for the MAPD and standalone drug plan part of Medicare, not the supplement part.
Let’s look at each type of plan and dissect them so the average person without any insurance training can understand and make the best choice for themselves.
Original Medicare And A Standalone Drug Plan
Original Medicare allows you to see any doctor, go to any hospital anywhere in the country if they take Medicare. Great flexibility, but there is one glaring issue that needs to be addressed. Original Medicare is the only insurance in the US that doesn’t have a maximum out-of-pocket, meaning you are responsible for 20% of the bill with no maximum to protect you from a catastrophic illness. As an example, you have a $400,000 hospital bill. Medicare will reduce that bill based on average pricing in your area to about $250,000. Your 20% is $50,000. Can you afford that? Most Americans cannot afford that kind of a bill. The drug plan is separate and mandatory regardless of whether you take medications or not.
Original Medicare, A Medicare Supplement, and a Standalone Drug Plan
This broker refers to this option as the Cadillac version of Medicare. You have Original Medicare, so the flexibility of choice is there, and you have the supplement to pick up the 20% that Medicare doesn’t pay. Great option but it has a price. Each Medicare supplement has a monthly premium that does increase as you age however the benefit is choice of doctors or hospitals anywhere in the country. The government designs the plans, but each insurance company can charge what they feel is accurate for the services rendered. The pricing varies by insurance carrier so look at the prices but remember you want a strong company who will be around even if they have significant claims. The smaller companies have better pricing but a catastrophic illness to a few of their members can raise the premium significantly. So, choose your company wisely. Since independent brokers do
not charge a fee and get paid form the insurance company, using them to assist in purchasing the best plan is a sensible solution to the Medicare maze. You still need a standalone drug plan to complete this option.
Original Medicare And A Medicare Advantage Plan Are Offered By Independent Insurance Companies
This is a very good option for most Americans and in Clark County Nevada there are 83 different choices of MAPD plans. The average senior with no insurance knowledge can get confused easily and using an independent broker is a wise choice. The broker cannot charge you a fee of any kind so choose one who has been in the industry for a while (8-10 years or longer) and is independent from the insurance companies. Remember all plans pay the same commission so the broker should be impartial and can help you find the best option for you. The most significant thing these independent brokers can do is make sure all your medications are covered under whatever plan you choose and that all your doctors are under that plan as well. Once the broker narrows down your options based on the criteria listed above you can then look at what ancillary benefits, if any, are offered by the plan to help narrow down your choice. MAPD plans are rich in ancillary benefits like gym membership, extra money to buy nonprescription medications like aspirin, etc. Depending upon the plan they have other benefits like physical, occupational and speech therapy services. They also offer hearing, dental and vision services, skilled nursing facilities, ambulances, routine transportation to and from doctor’s office or other medical facilities. Chiropractic, diabetic supplies and durable medical equipment supplies and podiatry services. As you can see these MAPD plans can offer significant additional benefits over what Original Medicare offers.
The issue for this broker is that these plans change their benefits annually, so you need to reevaluate your plan annually to be certain you have the best plan for you. Annually, each MAPD insurance plan tries to increase benefits to make them unique so you will choose them over the competition.
The independent broker can assist you in that endeavor and I encourage you to use them for that purpose.
Wrapping this up, someone new to Medicare will have a difficult time finding the best plan for them while all the insurance companies will inundate you with mail about their plans. Choose wisely so you can obtain the best medical services while enjoying some of the optional benefits available.
I’m going to get personal and explain how my wife and I picked our insurance to help you understand what is involved in making those decisions. My wife has no real medical issues, so a MAPD plan where all her doctors and medications are covered at fair prices was her choice. I, on the other hand, have Rheumatoid Arthritis and have had it for over 35 years. I need two shots monthly to eliminate any pain from the disease, and those shots cost $4000 per month. If I went the MAPD route, I would have to pay $800 per month for those shots until the Maximum out-of-pocket is reached and then pay nothing for the balance of the year. However, my current Rheumatologist does not take any MAPD plans so my option was Original Medicare with no maximum out-of-pocket or a Medicare Supplement with a standalone drug plan. The Medicare Supplement costs money, but when I factored in the doctor and the cost of the plan, the Medicare Supplement was best for me. A married couple, as shown above, will have different medical needs and that should be considered when choosing the best plan. Both spouses should be treated independently of the other when making your Medicare choice of plans.
By breaking each option down, I was trying to show what options were available and why you might choose one over the other.
You also might want to visit my website (www.insurance4unevada.com) where I have an Understnading Medicare document I’ve created and update annually to simplify the explanation of what Medicare is and your choices for service.
In Closing
Lastly, I want to mention that Medicare does charge for Part B and depending upon your income that rate could have a surcharge attached above the normal Part B changes for the year. The surcharges are based on income groups and change annually depending upon income and marital status. When planning your retirement please take these surcharges into consideration beforehand so you know what your cost is for your Medicare insurance.
My credentials are 23 years as a Medicare broker here in Las Vegas and not having one complaint or issue against me on that time. I carry Errors and Omission insurance in the event there is an issue but to-date, no issues or complaints, or claims. Member of NAIFA (National Association of Independent Financial Advisors) and NABIP (National Association of Benefits and Insurance Professionals).
Also, you may want to take a look at 2026 Medicare Information.
The Barend Agency Inc. Len Barend, broker 702-250-2200
