Signing Up For Medicare
Signing up for Medicare used to be complicated thankfully, our government decided to make it easy for any senior to sign up.
Simply go to www.ssa.gov. When the page opens, along the top are categories, and choose the one called Medicare. On that page is a tab that says Medicare or you can use the Apply button and sign up for Medicare.
The issue is what do you sign up for? Medicare has 2 parts. Part A is Hospitalization, and it covers anything relating to being hospitalized. The is a Part A deductible which for 2023 is $1600. Part B is everything outpatient like doctor visits or lab work or rehab. There is a small annual deductible of $226.
We are discussing Original Medicare only not adding either a supplement or Medicare Advantage plan. Will review that later.
Once the deductible has been satisfied, then Medicare pays 80% of the adjusted bill. For discussion’s sake say the hospital bill was $50,000. Medicare adjusts the bill based on where you live and other local factors, lowing the bill to $28,000. Then Medicare pays 80% of the adjusted amount leaving you with the balance of the reduced bill or $5600. The remainder is written off, so you owe nothing more than the $5600.
Understanding Part B
Part B works somewhat differently. The bill for doctor’s services is $130. Again, Medicare reduces that amount to $75 and then pays 80% of the $75 or $60. You still owe 20% or $12.00. The remaining balance of $15 is handled in a couple of ways. The doctor can write it off if they take the assignment of benefits (many doctors take the assignment of benefits, however, some do not). If they take the assignment of benefits, then you owe nothing. If they do not take the assignment of benefits, then you are responsible for the amount not paid by Medicare. Thankfully this is rare but does happen so asking the doctor before you book your appointment makes sense. If they do not take the assignment, you can still see them but will be responsible for what Medicare does not pay.
Once you have completed your application for Medicare Parts A & B you still have some decisions to make on what you want to add to Original Medicare to cover your other medical expenses. Suffice it to say that Medicare is the only insurance without a maximum out-of-pocket. If you don’t think that’s an issue, consider if your bill is now $300,000 and you owe 20% of that bill and you might think differently.
As stated above, Original Medicare is the only insurance without a maximum out-of-pocket. You have two choices to make and there are many factors to consider before making that decision. You can either add a Medicare Supplement and standalone drug plan or get a Medicare Advantage plan with a prescription drug called an MAPD plan.
Let’s Examine Each One Separately
Medicare Supplement and a standalone drug plan. Medicare supplements plans are designed by the government so all plan G’s are the same. That goes for all supplement plans. The design is the same but depending upon the carrier the monthly premium will be different. There are several factors to consider like premium, length of premium, and how much each carrier increases their annual pricing. I prefer to stay with the majors as smaller carriers are more susceptible to price increases based on premiums collected versus claims paid. Larger carriers are more able to absorb claims than smaller carriers meaning the price increase may be less with a larger carrier. These plans do not offer drug coverage so you need a standalone drug plan also. The reason someone might go this way is that their doctors only take a supplement and do not take any MAPD plans. Another reason is you have a medical condition that requires specific medications administered only in the doctor’s office and through the supplement there may not be any cost. The cost for these supplement plans is all over the board so choose the plan carefully and make sure what you need done is covered. As many of my readers know I have Rheumatoid Arthritis requiring a monthly injection costing $4000 per month. With the supplement, I only pay the monthly premium and that shot is covered. With an Advantage plan, I’d be paying 20% of the bill or $800 per month. The supplement’s monthly premium is more than half that cost so each month I’m on the supplement, I’m saving money.
The standalone drug plans premiums range from $7 per month up to over $100 per month with the average being around $25 to $30 per month. Depends upon the medications you take.
Looking At Medicare Advantage Prescription Drug Plans (MAPDs)
The Medicare Advantage Prescription Drug plans or MAPDs are different. The supplements are private insurance while these Advantage Plans are funded by the federal government and subject to different rules and regulations. Most of these MAPD plans have no monthly premium because the government is funding them. You can sign up for these plans during your initial enrollment period and can change them annually during the AEP.
The annual Election Period runs from 10/15 through 12/7 annually. You can also change our plan during the Open Enrollment Period or OEP (From January 1st through March 31st). Then you are locked into your plan unless you have a special election period which might be moving out of state or county for example. There are other reasons, but this is the most common one.
MAPD plans come in either HMO or PPO models. There is an MSA model, but it is not popular in Nevada.
Understanding HMO
Typically, the HMO plans require a referral to see a specialist but at least one plan does not require a referral to see a specialist and another plan allows nationwide access. All other HMO plans do require a referral to see a specialist and are not available nationwide unless it is urgent or emergency.
Understanding PPO
The PPO plans are typical of all similar types of plans meaning no referral and nationwide coverage in and out of the network. The PPO plans monthly premiums are usually at no cost, but several do have monthly premiums ranging from $25 to $120 per month depending upon plan and carrier. The out-of-pocket costs for services are higher than the HMO as well. That is the price you pay for the flexibility of the PPO.
In Clark County, as many as 140,000 seniors are enrolled in MAPD plans. These plans are well designed and attract many seniors especially those on fixed incomes who want good coverage without the expense. The restrictions are the doctor network. Not all doctors take all plans so be careful and have your broker confirm that your doctors take the plan you are enrolling in and that all your medications are included. All hospitals participate in these plans.
To wrap things up you can either choose the supplement and standalone drug plan or choose an MAPD plan. Cover all your bases so when you decide you are choosing the best plan to meet all your medical needs.
I am available for a no-cost consultation via phone, email, or text and will answer any questions you have about Medicare and the plans available in your area.
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
Cell:702-250-2200
Email: len@insurance4unevada.com