While retirement translates into a vast array of lifestyle changes such as traveling, having more opportunity to spend time with grandchildren, volunteering, or finally getting to simply relax, there is one commonality and a top priority: health care and the coverage to help pay for it.
There are several options to assist with the out-of-pocket health care and Medicare costs. Medicare beneficiaries can select a traditional supplement plan and a prescription drug plan or alternatives such as the Medicare Advantage program. All the different nuances can be quite confusing. I have asked Mandy Glover to provide some helpful information about the Medicare Advantage plans. She helps her clients review their coverage. The following was provided by Ms. Glover:
Medicare is the largest government sponsored health insurance program in the United States that pays some of the health care expenses for people who are 65 or older or who are eligible because of a disability or qualifying health condition.
Many Medicare beneficiaries select private companies approved by Medicare to provide health care and prescription drug coverage. Medicare Advantage plans are alternatives to original Medicare for receiving Medicare benefits. These plans are available from private companies that contract with the Center for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare program. The plans have at least the same benefits as Medicare Part A (hospital coverage) and Part B (medical coverage). Most offer prescription drug coverage (Part D), and many offer extra benefits not covered under Parts A & B.
Some of those benefits include lower out of pocket costs, benefits such as hearing and vision screening or dental care, co-pays for prescriptions and increased prescription coverage by providing Generic Drug Coverage in the gap. MA plans typically eliminate cost sharing requirements for many preventive services that Medicare covers: covers routine physical exams regularly, not just on entry to Medicare as the traditional program does; and incorporate selected health education and wellness benefits, many of which are uncovered in Medicare, and some plans have eliminated Medicareís inpatient hospital day limits and are covered through a co-pay.
To be eligible to join a Medicare Advantage plan, you must live in the planís service area, be enrolled in Medicare Part A & B, and not have end-stage renal (kidney) disease. There are also Special Needs Plans for people with specific diseases or specialized health needs.
Medicare Advantage members must pay their Medicare Part B and typically an additional plan premium will vary by plan. Some Special Needs Plans will have $0 premium.
There are four types of plans:
? HEALTH MAINTENANCE ORGANIZATIONS ó In most cases Medicare HMOs require their members to use doctors, hospitals, and health care providers under contract with the HMO network.
? PREFERRED PROVIDER ORGANIZATIONS ó PPOs also have networks of doctors, hospitals, and health care providers under contract.
? PRIVATE FEE-FOR-SERVICE PLANS ó You seek care from any doctor, hospital or other providers that agree to accept the private fee-for-service planís terms of payment. No referrals are needed to see specialists.
? SPECIAL NEEDS PLANS ó These plans provide focused health care for people with specific diseases or specialized health needs covered by the specific plan. Some plans are for people in long-term care facilities or those dually eligible for both Medicare and Medicaid, people with end-stage renal (kidney) disease or those with high cholesterol, high blood pressure or diabetes.
Your coverage can not start before your Part A and B coverage begins. For Medicare Advantage plans, you can apply for coverage three months before, the month of, or three months after your Part B coverage starts.
If you didnít recently become eligible for Medicare, your options are different depending on the time of the year. Medicare has set several timelines and provisions in which Medicare beneficiaries can enroll, change their coverage, or disenroll from the current plan. But even if not recently eligible for Medicare, there are some exceptions that allow you to enroll in a prescription drug plan or Medicare Advantage plan any time during the year
For more information as to eligibility for the different plans or changing your current coverage, you may call Mandy Glover at 956-971-8585 or 956-648-1852.
Mary Garza Cummings is a freelance writer. The Town Crier does not warrant the information as valid. It is the responsibility of the reader to ensure validity of the information. If you have questions or comments, email firstname.lastname@example.org.