It's time to choose your health and prescription drug coverage for 2018 -- and your current plan may no longer be the best fit for you. Reviewing your Medicare plan can help you save money or get better care - or BOTH in 2018. These are the five things you need to know now when selecting a plan.
HMO vs PPO
Your choice in selecting an HMO or a PPO is the difference between whether you are restricted to seeing a network of doctors or will need a referral to see a specialist. As a member of an HMO, you must see doctors within the insurance carriers network (which vary vastly between carriers) to seek medical care and may need a referral to see a specialist within the network.
Generally with PPOs, you pay a smaller co-pay if you see a doctor within the insurance carriers network, but are covered if you see a doctor outside of the network (as long as the doctor will accept the insurance). There are no referrals to see a specialist, and you can travel without worrying if you’ll be able to find a doctor in a local network.
Part B Rebate
Many HMO plans offer what is known as a Part B rebate. A newly eligible Medicare beneficiary will pay $134 premium for Part B in 2017. This generally comes out of your social security payment. Plans in the Tampa Bay Area offer rebates ranging from $80 all the way to $105, which means less coming out of your social security. However, this doesn’t necessarily mean a rebate plan will be best for you. Rebate generally apply only to HMO plans, meaning you’ll be restricted to a network. There is also a plethora of other considerations to make about a plan. What is the hospital co-pays on these plans? Is your doctor in their network? How often do you see a specialist? These are all questions you should be asking yourself and your agent.
Medicare and Medicaid
Most people don't know if they're eligible for Medicaid or Low Income Subsidies (LIS, which offsets the cost of prescription drugs), and trying to determine this for yourself can be a challenge. Attached below is the chart regarding Medicaid income limits for the state of Florida.
This chart shows the monthly income limits for different levels of Medicaid coverage. For example, QMB limits (full Medicaid) are $1,354 for a couple or $1,005 for an individual. SLMB limits (pays for Part B Premium only) is $1,624 for a couple or $1,206 for an individual. Finally LIS limits (pays some prescription costs) is $2,030 for a couple or $1,508 for an individual. If you are Medicaid-eligible, you can enroll in special Medicare plans called D-SNPs that coordinate benefits between Medicare/Medicaid and offer additional benefits. Also, D-SNP beneficiaries may switch plans at any time during the year, not just during open enrollment.
Hospital Co-pays, Networks, Drug Coverage, Out-of-pocket limits, and Estimated Annual Cost
These are all factors that need to be considered when choosing a Medicare plan, not just the co-pay when you see your doctor or specialist. Some plans offer a $3,400 out-of-pocket cap, while others have $6,700. Some plans charge $0 copays for hospital stays, some charge $450 daily for the first four days. Some plans have networks of 14,000+ local physicians, some only 1,000. This shows that no Medicare plan is right for all, there is no such thing as "one-size-fits-all" when it comes to your healthcare. Do you know what your benefits are? Below is a link to the Tampa Bay Times 2018 Medicare Chart, which allows you to categorize all available MAPD plans in the Tampa Bay Area by co-pays, network size, out-of-pocket limits, estimated annual cost. Compare your current coverage and think about what is most important to your in a health plan.
Tampa Bay Times Medicare 2018
Be Proactive with Your Healthcare
Make sure you are reviewing your coverage every year. Your plans might not change names year-to-year, but your benefits might. Doctors enter and leave a plan's network. Co-pays might change. If you are thinking of switching to a different plan, some of the important things to consider aren't always spelled out in black and white. Do you know somebody with the plan you are considering moving to? What has their experience been like with the plan? What is that plans Medicare Star Rating? Is your doctor in this new plan?
This is why it is important to have a reliable independent agent. Working with an independent agency like Retirement Advisory Consultants means we represent the majority of the Medicare plans in the area, not just one carrier. We welcome annual benefit reviews with our clients to ensure that they are in the plan that offers them the most value at the lowest annual cost. If you are thinking about switching plans, give us a call at 866-868-9292 or at 727-807-2343. We are more than happy to answer any questions you may have about your current or future coverage.