Choosing a Medicare Advantage Plan and Medicare Part “D” (Prescriptions)

by Michael on July 14, 2008

in Health insurance,Medicare,Prescriptions

The idea is simple enough: ‘Let’s help folks on Medicare save money on their health care expenses.” See, Medicare pays for some but not all medical costs – and basically NONE of the prescription medicine costs. The implementation, however, was far from simple! It seems unlikely that anyone could make it more complicated and confusing for people if that were their aim. (And I am not so sure that is not the case). So, lets take a little of the “mystery” out of this whole Medicare supplementation thing.

A little background: The Medicare program began under President Johnson, and it’s stated purpose was to provide help with medical costs for people as they retired. When it was implemented, medical costs were comparatively low. There was no provision to pay for something as minor as prescriptions. There just was not the need. However, in the decades to come, as medical advances were made, particularly in the area of prescription drugs, costs rose many, many times what anyone could have predicted. Combine that with what seems to be a longer lifespan, thanks to these advances in medicine and drugs, and now we’ve got a program that’s trying to support far more than it was originally designed to support.

Since prescription drugs are no longer a minor part of a person’s medical expenses, people were crying for help in this area. For many, these drug expenses were taking their entire monthly income. So, in response to this need, Medicare Part “D” was born. A plan to help pay for prescription drugs.

At the same time, Medicare Part C was born. The so-called “Medicare Advantage” program. It is essentially, the privatization of Medicare. A person can choose to have their health claims paid by a private insurer (as opposed to the Government) and in so doing, they may save considerable amounts of money – because of having their extra medical expenses covered – over what having just standard Medicare and a Supplement (Medi-Gap policy) will pay.

Well, that is a nice thought. Saving money. We all want to do this.

But in setting up this program, Congress created a new organization to oversee it. This is referred to as CMS. Those of us that help people choose which program is best for them, are required to undergo certification with CMS, each year, for every company we are authorized to help people with.

Regular Medicare is well established and we all understand the rules. Insurance companies who sell Medi-Gap Policies (Supplements) generally do a good job, and the main focus is which company does it at the best price, But this is not the way of Medicare Advantage programs. Although they do save people money, the fact that the CMS organization changes policies each year, makes re-evaluating policies yearly, and perhaps CHANGING to something different each year, the wisest course for consumers. (Why anyone would think this type of management makes sense, I will never understand. None-the-less, I do the yearly certifications, because I want to be ready to help my clients to make the best choice for them each year.)

Medicare Part D (Prescription Coverage), can be combined with a Medicare Advantage plan – or original Medicare. While also a somewhat “flawed” system, when measuring Medicare Part D out by cost-versus-savings, it is almost always a winner for the consumer. So whereas there could be things done to make it better, I believe that almost everyone on Medicare should have Medicare Part D.

When should a person start making these decisions?

If you are just enrolling in Medicare, it would be best if you did the research and chose a plan (call me and I will help you) the month prior to enrolling in Medicare – although this can all be done the month you enroll too.  As it stands now, changes in your options can be made once a year.

So, if you are not getting the most benefit from the plan you currently have, or if you are just now about to enroll in Medicare and want to shop Advantage Plans or Medicare Part D (prescription plans), please feel free to contact me, and we can get you enrolled in the best plan for your individual needs.

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