Medicare is a great Health Insurance

Medicare

Medicare is a great Health Insurance for most beneficiaries, but it does not cover everything. With Medicare, you are responsible for the A and B deductibles and a 20% co- insurance. However, there are people who do not want Medicare because they do not want to pay the Medicare Part B premium of $144.60; Regardless, canceling Medicare Part B is a big mistake! It could cause you bigger problems later. There are plan that can help you pay for that premium. If you do have low income, you could help you qualify for extra help with the state.Below are some other options to consider to fill in the gaps in addition to Medicare Part A and B:

Many Medicare Advantage Plans (Part C) have no monthly premium. Why at no cost? When the beneficiary enrolls in one of these plans, the Center for Medicare and Medicaid Services (CMS) sends the insurance company a check every month for your enrollment. So Medicare is paying for your premium.  This check is not the amount for the Part B premium, it is for a lot more. Now, the insurance company is responsible for 100% minus the co-pays, if any. This process helps Medicare reduce insurance fraud and the beneficiary gets affordable healthcare. With these plans, the primary Doctor copay is usually $0, they get a Part D plan and many other benefits with a low copay. The beneficiary still have to continue to pay for the Part B premium. These plans include:

 *Home Maintenance Organization (HMO) *Preferred Provider Organization (PPO)

*Medical Saving Account (MSA)

Medicare Supplements (Medigaps) are considered the Cadillac Medicare Plan. It help fill in most of the gaps that Medicare does not cover. Gaps like 20% co-insurance and copays.No networks to worry about. It works different and is more expensive than Medicare Advantage Plans.  Medigap policies are sold by private companies. These private companies make their profits from the monthly premiums and not from CMS like Medicare Advantage do.  The older you get, the higher the premium.  Expect the monthly premium to go up every year. All these Medigaps Plans are standardize and cover the same benefits. It is recommended to compare other company’s prices and switch when possible in order to obtain a lower premium.

TRS-Care- Retire Teachers with Medicare. This plan is the most expensive Medicare Advantage plan in the Texas. At present, the monthly premium is $135 a month with a $500 deductible. Fees this high can put a strain on all retired teachers with fixed income.Because TRS members have had TRS insurance for most of their lives, they are not aware of the outside competition. For example, HMOs have $0 premiums and PPOs are available in almost every area of the state with $0 or small monthly premiums. Even Medigaps could be less expensive with more advantages than those offered by TRS- Care.Many teachers are afraid that once they leave TRS, they will never be allowed to go back, but we have helped hundreds of TRS members switch from TRS into an independent plan and not one of them has ever asked to return to TRS. The TRS system is broken and it is continuing to get worse. We recommend you look for other plans available in your county and compare the benefits. Even better, give us a call and we will help you find a much better plan than TRS.If you are a TRS retiree, you owe it to yourself, your family, and your financial future to learn all your options as soon as possible. 

Is a Medigap the best Medicare Plan available?

YES, IT COULD BE, BUT NOT FOR EVERYBODY

Please don’t be lure by agents or agencies who only offer one Product. Medigaps Sales agents have these fancy websites and YouTube videos telling to spend your money only on a Medigap.  They don’t sell Medicare Advantage Plans and many don’t even sell the Part D plans.  These people use the Scary Tactics to lure you into buying a Medigap and trash other products.  They try to scare you with talk to you about high deductible, Doctors leaving the network and the hassle of paying co-pays. 

This agents are offering the product which requires the least service for them and the most expensive for the client.  They don’t want to deal network or formulary issues. They don’t want deal with the customer during the Annual Enrollment Period (AEP).  Walk away from Agents that only offer Medigaps and who have bias opinions.

Important questions before making a decision:
 Can I offer it or I am in a budget?
 I am healthy or I am too sick?
 Do I travel too much or not?
 Do my doctors participate in the programs or not?

Many beneficiaries are paying too much for a product that they are not even using.  Is like having a Cadillac in the garage when other vehicles can do the same job at a much lower cost. Spending money on a Medigap could be a good decision.  That decision should be made after all the other options are compared. Before you make a decision on a Medigap, get inform. We can help.

Medigap policies have many benefits:

  • During Open Enrollment or Guarantee Issue period one can enroll in any Medigap plan with no questions asked.
  • No networks. You can see any doctor who accepts Medicare anywhere in the USA.
  • Coverage when you travel outside the U.S. (minus a deductible and co-insurance).
  • Many of these plans have no copay nor deductibles.
  • Guarantee renewal as long as you pay your monthly premium.
  • Able to switch to another Medigap plan at any time as long as you medically qualify.

Disadvantages:

  • The Part B premium needs to be paid.
  • No part D plan. Part D plan need to be purchase separately.
  • No extra Benefits: Dental, Vision or other items is not included.
  • Price increase every year.
  • Does not cover Long-term Care.

 

MEDICARE ADVANTAGE ENROLLMENT PERIODS

Initial Enrollment Period (IEP)

  • 3 months before effective – effective month – 3 months after effective

Annual Enrollment Period (AEP)

  • October 15 to December 7 (Changes effective January 1st of following year)

Open Enrollment Period (OEP)

  • January 1 to March 31

Special Enrollment Period (SEP)

  • Have Extra Help/Loss Extra Help
  • Have Medicaid/Loss Medicaid
  • Moving In/Lost Employer Coverage

General Enrollment Period (GEP)

  • January 1 to March 31 (Enrolling in the Part B)
  • Effective July 1 st

What should I do?

Before you buy a Medigap or enroll in a Medicare Advantage plan, learn the difference and
find all your options. Choose your plan carefully. You are only able to change Medicare
Advantage plans during the Annual Election Period.We can answer your questions, help you compare plan options, and give you information
about how to enroll in a Medicare plan. Call our office or fill out the request form.