Here are some interesting statistics about Medicare and what it means.
Starting with the number of Medicare recipients:
65,103,807 seniors are enrolled in Medicare
34,984,295 have Original Medicare
50,574,579 have Part D
30,119,472 have an MAPD Plan
When you look at those on Medicare and then look at those on Original Medicare along with those that have an MAPD plan, the total numbers appear to be ok. The part that does not add up is the 50,574,579 who have Part D. That number appears to be low because everyone on Medicare is required to have a drug plan.
Nothing is mentioned about a Medicare Supplement. (Medicare Supplements are private insurance and perhaps those numbers are not available.) I believe the answer is that those with a supplement are really covered by private insurance while the standalone drug plans and MAPD plans are essentially government sponsored and money is provided to the insurance companies to help reduce the cost of insurance for seniors. The government does not have adequate statistics about Medicare Supplements. That still doesn’t explain the difference between the total number of Medicare recipients and the lower number of recipients who have Part D.
Medicare Advantage Prescription Drug
Let’s review why a senior chooses one method of coverage over another. To begin with, those seniors choose an MAPD plan for many reasons among them the zero monthly premiums. Thus, almost half all seniors have MAPD plans. The other reason is that these plans combine all aspects of medical care including drugs.
Choosing one MAPD over another usually means their doctors and medications are covered in the plans. The real answer is that MAPD plans provide many services not available with Original Medicare with or without a supplement. Things like a monthly allowance for non-medical items like aspirin, all kinds of bandages, gym membership, etc. Some plans even offer money to buy groceries. Many seniors are living on a fixed income, so these extra benefits allow them to stretch their budgets.
Many seniors choose to stay on Original Medicare and get a standalone drug plan because they can choose any doctor, any hospital that takes Medicare nationwide. A great benefit but without any backup. Original Medicare does not have a maximum out of pocket like all other insurance plans. This is not
mentioned normally but needs to be considered when you decide to choose one type of insurance versus another.
Meaning you are financially responsible for the 20% that Medicare does not pay with no maximum out of pocket. If you have a major illness like cancer or a heart attack the overall cost could be more than $200-300,000. You would be responsible for the 20% that Medicare does not pay or in this case,
$60,000. If the bill is higher, you still pay the 20%.
If you have Original Medicare and a standalone drug plan you should consider a supplement because it covers almost anything else. That’s assuming you can afford the monthly premium for the supplement.
Adding a supplement eliminates those expenses. You are responsible for the monthly premium and a small under $300 annual Part B annual deductible. Everything else is covered between Medicare and your supplement.
Another aspect to consider is the term assignment of benefits. This means you sign over the right for the doctor or facility to bill Medicare directly and get paid directly. It also means that the doctor or facility can bill you the difference that Medicare disallows, meaning in addition to the 20%, you also have to pay that disallowed amount which represents about 15% of the bill. That’s 35% of the total bill and can be very expensive.
Many seniors cannot afford the monthly premiums of these supplements, so they investigate alternative like the various MAPD (Medicare Advantage Plans including drugs offered by many insurance companies in Nevada).
MAPD plans are plentiful here in Nevada and all offer additional benefits, like gym membership and other incentives over what Original Medicare provides so they are very attractive to many seniors.
Most of these plans do not have a monthly premium and have very rich benefits. That is the deciding factor when choosing your Medicare plan. However, many times seniors pick a plan for any number of reasons. In my case I have RA and need the supplement because of the medication administered by the doctor in their office. That medication falls under Part B, not Part D. Having it done in the doctor’s office eliminates any cost to me other than the monthly premium for the supplement. My wife does not have any medical issues, so she has an advantage plan with no premium and all her medical needs are covered.
Cannot stress enough that most seniors do not have the expertise to figure this all out by themselves. Insurance brokers cost the senior nothing as we are not allowed to charge for our services under NV law. We have the knowledge and experience to help you choose the best plan that fits your needs. That expertise includes figuring out what plan will work best based on your doctors and medications so take advantage of our knowledge and experience.
With 82 different plans in Clark County it is too easy for a senior to not consider all their medical needs and other considerations when choosing a plan. Realistically, these plans can be changed during the Annual Election Period or AEP which is from 10/15 through 12/7. The Open Enrollment Period is from 1/1 through 3/31. During the OEP you can only change your Medicare Advantage plan but not your standalone drug plan. The drug plan can only be changed during AEP.
Many seniors are not aware of these significant differences which could have serious financial consequences if their plans are changed during the correct time frames.
As you can imagine, seniors have many decisions to make and not a lot of time to make them. Also, the airwaves have been inundated with commercials about Medicare and so many different offers from the insurance companies that making a correct chose is not always possible. That’s why I suggest you seek counsel from a Medicare broker. We are contracted with most if not all of the plans in the area and we can guide you to the best plan for you. We cannot charge you anything and we are impartial to the plans as all plans pay the same compensation so that aspect should not be an issue.
All plans make some changes annually so it is a good idea to have a what’s new meeting with your broker to see if you need to change your plan.
Having stated everything that is available, please take a look at the new additions to your current plan to see if it still meets your medical needs.
I hope this information is useful and it anyone has questions, please contact me via phone or email and I will respond quickly.
Also take a look at Medicare 2023 Information.
The Barend Agency Inc.
Len Barend, Broker