Medicare Info
Medicare is unique because of several factors. One is that with Original Medicare there is no maximum out of pocket. You are on the hook for 20% of all bills and could be responsible for an additional 15% under certain circumstances. The other issue, while not as damning as the first, is that not all doctors take Medicare. While the majority take it there are still pockets across the country where doctors do not take Medicare. In Nevada most doctors take Medicare but there are some who do not take it.
The decision to go onto Medicare is about as confusing as it could be. In Southern Nevada there are 84 different Medicare options. How is a senior going to navigate this minefield? Few can but the rest should contact a Medicare broker who understands the local marketplace and can guide you to the best plan for you. Brokers cannot charge for their services, as they get paid from the insurance company and all insurance companies pay the same commissions on MAPD and PDP plans.
Most popular option: Medicare Advantage Prescription Drug plans known as MAPD plans. 54% of seniors choose this option, The plans are well thought out with many ancillary benefits available like gym membership, money to buy either food, gas, pay rent, etc. Not all plans offer this array of ancillary benefits, but many do, the benefits will vary by carrier. The real reason these MAPD plans are so popular is they usually have no monthly premiums and low copays for services. Very popular with those on fixed incomes.
These plans offer more than Original Medicare and do not have the risk of no maximum out of pocket. The downside is that there are networks of doctors, and you need to make sure your doctor takes that plan. Once you’ve determined your doctor is in their network you should check your medications to determine if they are covered and at what cost. Those two steps in my mind are mandatory before you pick a plan. Suggest you find a local Medicare broker who can do the work for you. As stated above they cannot charge for their services and are knowledgeable of the local marketplace.
The other option is to purchase a Medicare Supplement and a standalone drug plan. Supplements ae private insurance and have monthly premiums that go up annually. The major benefit is you can go to any doctor, go to any hospital anywhere in the country if they accept Medicare. Thus, your choices are many. You can change your supplemental plan annually because of the Nevada birthday rule which I co-authored allowing you to change plans annually during the month of your birthday and the month after your birthday. There is no underwriting. Drug plans can be changed annually during the AEP.
Remember, when you ae first eligible for Medicare you have a 7-month window to find a plan. You have three months before your birthday, the month of your birthday and the three months after your birthday to choose a plan. Depending on when your birthday month is you could be on that plan for quite some time. You also have the Annual Election Period from October 15-December 7th to change your plan. You can change as many times as you want during the AEP but after December 7th you will be enrolled on the last plan chosen. The plan starts January 1st of next year. Then you have the OEP, Open Enrollment Period where you can change your MAPD plan once between January 1st and March 31st. You cannot change a standalone drug plan during the OEP.
The other option is called an SEP, Special Enrollment Period, where under specific circumstances you can change your plan one more time. Typical SEP reasons include but not limited to; move into the state, lost your group insurance and are eligible for Medicare, disabled and several other reasons.
Beyond Logic
The illogical part of Medicare is some of their rules make no sense, like during AEP you can changes standalone drug plans but during OEP you cannot. Yet during OEP you can change your MAPD plans which include drug coverage. How does that make any sense? The other most egregious item is when you didn’t enroll into Medicare when you should have, you of course pay a lifetime penalty, but you can only signup in January for a February 1st effective date. Until recently you had to wait 6 months to start Medicare, meaning July. Thankfully that has been addressed. The interesting part of Medicare is that they claim to be broke, yet they take people who really don’t want to go onto Medicare as described above yet are forced to enroll.
I believe several reasons account for the shortfall. The most blatant one is Congress does not have to go onto either Medicare or Social Security as they have much richer plans available to them, and they’re not participating means they really don’t care about those plans, and they are both going broke. Consider that there are 454 members of both houses and while the turnover is slow there must be more than 10,000+ former members of Congress who are also not on Medicare or Social Security. That’s significant loss of revenue to both Medicare and Social Security. Just consider the current members or 454 times the 7.65% of Social Security up to an income of $168,000 which is the base rate maximum. There are surcharges for those making more than $168,00 which all members of Congress would pay. The base rate is .07654 times $168,000 which is $12,852 per member.
Meaning the total amount lost annually is $5,834,808 plus the extra income surcharge on the remaining Congressional salaries. Yet they vote on changes but are not contributing. Not what our founders wanted.
Suffice it to say there are significant shortfalls not being addressed and the main reason is Congress is not on either Medicare or Social Security. There is only one way to change this, and it is with the Convention of States. 35 states must participate and that is a very tall order. Congress will never vote to change it themselves, so we must do it for them.
This is an overview on some of the items that need to be addressed. Unfortunately, they are not being addressed.
If anyone has questions, don’t hesitate to contact me via phone or email, and I will respond quickly.
Also, if you need Medicare information, take a look at Medicare 2024 Information
The Barend Agency Inc.
Len Barend, Broker
Cell:702-250-2200
Email: len@insurance4unevada.com