Are you a senior in the Reno/Tahoe, Nevada area struggling with what to do during Medicare Open Enrollment? Open enrollment can be a stressful time. Navigating the intricacies of original Medicare vs the endless Advantages Plans can be overwhelming. First, let’s explore what Medicare is, and then let’s look at the important differences between original Medicare and Medicare Advantage Plans.
The Basics of Medicare:
- Medicare enrollment starts at age 65 and consists of 3 parts:
- Part A is hospital coverage. This coverage is usually free. If you get admitted to the hospital you will pay a $1500 deductible and then $0 per day for the first 60 days. Each time you are admitted you must pay the deductible and if you are hospitalized for over 60 days you will have to pay a certain amount per day.
- Part B is medical/outpatient coverage. This coverage typically costs $148.50/mo. In addition to that, you will pay a $203 deductible before Medicare will start covering any cost. Once you pay the monthly fee and reach your deductible Medicare will cover 80% of the cost and you will need to pay the remaining 20%. There are some preventative health services that are entirely covered by Medicare.
- Part D is prescription drug coverage. This coverage is completely optional. The monthly cost and premiums vary widely based on the plan that is chosen.
- Two important things to remember
- Your monthly premium will increase if you enroll after age 65.
- There are no out-of-pocket maximums. Prolong hospitalizations can add up quickly.
***The monthly premiums and deductibles listed are the most common. These can change based on your income and when you enroll in Medicare. Check out medicare.gov for the most up-to-date pricing. ***
Part C: Advantage Plans. These plans are offered by private insurance companies and bundle Parts A and B and usually part D together with other benefits such as vision, dental, transportation, and gym memberships.
Medigap: Is private insurance that can be purchased at an additional cost to help cover out-of-pocket expenses.
Medicare Enrollment Periods:
Open Enrollment: From Oct 15th – Dec. 7th anyone on the original Medicare or Medicare Advantage plan can switch, add, or drop coverage. If completed by December 7th coverage starts January 1st.
Advantage Plan Open Enrollment: From Jan 1st to March 31st anyone currently enrolled in a Medicare Advantage plan can change advantage plans or switch to original Medicare. You can only make one change during this time frame.
Original Medicare vs Medicare Advantage Plans:
Which is better? Truthfully, one plan is not superior to the other. The key is choosing a plan that best aligns with your personal health goals. The devil is in the details It is critical that you read and understand the fine print of each plan.
On paper, Advantage Plans offer more services for less cost. Why do private insurance companies do this? Medicare pays private insurance companies a set amount per enrollee. The private insurance company is betting that you will cost them less than what Medicare will pay them. They stack the odds in their favor by requiring that you stay in-network for your services. Therefore, they will make money on any labs, images, procedures, hospitalizations, or specialty services that are required. Medicare Advantage plans spend A LOT of money marketing to seniors, and they tend to profit nicely for every senior they sign up.
The advertised benefits of Advantage Plans are all the extras; dental, vision, gym membership, medical transportation, out-of-pocket maximums, and reduced copays. The disadvantage is the loss of medical autonomy and choice. You will no longer be able to choose who delivers or where you receive medical care. Want to see a doctor instead of a nurse practitioner or physician assistant? Well, you may not have a choice. Hoping to see a certain specialist, or need an expensive imaging test? It will need to be "pre-authorized" first. Some services may not be "covered" after all and the hassle factor of having to go through "managed" care hoops may actually delay or impede care. This can make navigating Advantage Plans extremely frustrating for patients. The "original" or "plain" Medicare offers the most flexibility.
A concierge direct primary care practice (DPC) like Preferred Family Medicine can help seniors navigate the healthcare market without the limitations often inherent to Medicare Advantage plans. If you want the freedom to see any specialist, or go to any hospital and desire a more personalized primary care experience (i.e. longer face-to-face time, continuity, and direct access to your doctor), concierge DPC may be for you. Financially, there are perks with using a concierge DPC practice, including access to deeply discounted medications via an in-office pharmacy, in-office lab testing, and the freedom to explore free-market healthcare options.
Ultimately, seniors need to decide for themselves what they value the most when it comes to their healthcare. We are available to answer any questions and give honest advice so you don't get "stuck" with a plan you are unhappy with.