On Medicare

Barry_Atwood_ as_ a boy

Young Barry Atwood

The first Medicare premium arrived this week. I suppose that makes it truly official. Young Barry Atwood is now on Medicare. His 65th birthday isn’t until November 25, but if you sign up during the first three months of your enrollment period, coverage begins on the first day of the month you were born.

Applying for Medicare was easy, but deciding which coverage to choose was anything but.

Original Medicare vs. Medicare Advantage
Some people think you just sign up for Medicare and you’re automatically covered. If only it were that simple. You need to decide if you want original Medicare or a Medicare Advantage plan. And the decision-making doesn’t end there. Within each choice are lots of other choices. For instance, original Medicare doesn’t cover prescription drugs. If you want to add it, private insurance companies offer multiple plans. I was so mired in all the choices I was seeing little white pills in my sleep. You may also want to buy a supplemental or Medigap policy to cover some of the things original Medicare doesn’t, such as co-payments and deductibles.

Medicare Advantage plans offer basically the coverage as original Medicare, but most plans also cover prescription drugs and some include extra coverage, such as vision, hearing, dental, and/or health and wellness programs. The policies are sold by private insurance companies, and comparing all the different options was even more challenging than comparing the prescription drug plans. The first step was taking a closer look at the differences between original Medicare and the Medicare Advantage plans.

Before I make some comparisons, I want to give you a brief explanation of Medicare Part A and B.

Medicare Part A covers

  • Inpatient hospital care
  • Inpatient care in a skilled nursing facility
  • Hospice care
  • Home health care services

You don’t pay a premium, but may be responsible for co-payments, coinsurance, and deductibles.

Medicare Part B covers

  • Doctor’s visits
  • Outpatient care
  • Home health services
  • Durable medical equipment
  • Some preventive services

You pay a premium and may be responsible for co-payments, coinsurance, and deductibles.

Now let’s compare original Medicare to Medicare Advantage plans

Original Medicare

  • Includes Part A and/or Part B
  • Coverage provided directly by Medicare
  • A choice of providers as long as he/she accepts Medicare
  • Patient is responsible for deductibles and co-payments
  • Premium for Part B; none for Part A
  • Doesn’t include prescription drug coverage
    • Medicare approved private companies offer several drug plans for a monthly premium
  • Supplemental insurance (Medigap) may be purchased from private insurance companies
    • Necessary to have Medicare Part A and Part B
    • Premium in addition to Part B premium
    • 10 plans (A, B, C, D, F, G, K, L, M, N) which, in the Portland, Maine area, are sold by about 12 different companies
    • Covers some co-payments, coinsurance, and deductibles
    • Some plans offer additional coverage
    • If you already have a prescription drug plan, you can’t get a Medigap policy that also offers drug coverage

Medicare Advantage Plans

  • Referred to as Medicare Part C or an MA
  • Several plans offered by Medicare approved private insurance companies
  • Include both Part A and Part B coverage, but you get the coverage from the Medicare Advantage plan, not Medicare
  • Plans include HMOs, preferred provider (PPO) plans, private fee-for-service plans, and special needs plans
  • Usually have to use healthcare providers in the plan’s network or you may pay additional or all costs
  • Most plans include prescription drug coverage
  • In most cases, monthly premium in addition to Medicare Part B premium
  • Illegal to have a Medicare Advantage plan and a Medigap policy
  • May offer additional coverage e.g., vision hearing, dental, and/or health and wellness programs
  • Each plan can charge different co-pays and out-of-pockets costs, which are important to consider when comparing plans

Where to learn more about Medicare
There is no way I can get into the level of detail that exists about Medicare options. The official U.S. government 2012 Medicare Handbook, which I have now read several times, or at least sections of it, is 148 pages long. Here in southern Maine, I highly recommend that you attend one of the Medicare seminars offered by Southern Maine Area on Agency. One of its Medicare experts, Carol Rancourt, advised me to compare health plans on the Medicare website. “In our zip code area of greater Portland, 10 Medicare Advantage plans are going to come up,” she explained when I asked how to compare plans for my husband. “He can look and compare all of those, he can do three at a time. He can look at the drug coverage and he can look at the health coverage. You’re not just looking at premiums, you’re looking at co-pays. The real cost is in the co-pays.”

Barry chooses a plan
When we first began to research Barry’s options we were drawn to the Martin’s Point Generations Advantage plans, simply because his primary care provider is at Martin’s Point and we’ve been happy with the services we’ve received. In the end, we chose the Martin’s Point Generations Advantage Select Plan, which is a PPO. In addition to a monthly premium of around $100 paid directly to Medicare for Part B, we will pay $39 a month to Martin’s Point. We’ve been paying more than $600 a month for his benefits through COBRA, so it’s a huge difference. We chose the PPO over the HMO because we have always preferred to make our own decisions about seeing a specialist rather that asking for a referral.

After all the reading and comparing, making the choice was rather anti-climactic. Barry simply called the number on one of the half dozen information packages Martin’s Point had sent him over the past few months and he was signed up in minutes. (To be fair, AARP outdid Martin’s Point on the number of Medicare mailers it sent him and a couple other insurance companies weren’t far behind!) I do not expect coverage to be much different from what we are used to. It will be less expensive if he sees providers in the plan’s network, but the network is fairly large and not limited to only Martin’s Point providers. The same is true for drug coverage — he may go to any pharmacy in the network, not just the Martin’s Point pharmacy.

What other people say about Medicare choices
I asked some people who were already on Medicare what plans they were on and if they were satisfied. Their plans included original Medicare and the following Medicare Advantage plans: NE Community Care, Martin’s Point Generations Advantage Prime, Aetna Medicare, and United Healthcare (AARP). Surprisingly, no one had any major complaints. Medicare also uses a star rating system for its Medicare Advantage plans that is based on member satisfaction surveys. The Martin’s Point Generations Advantage Prime plan was the only one to get five stars — the highest rating. Although it’s the HMO plan and there is not enough data yet on the PPO plan we selected, I thought the rating was meaningful.

So that’s it. Barry is on Medicare and, cross our fingers, he will not need to use it for anything but wellness visits. We’ll put it to the test fairly quickly — I don’t think he got his flu shot yet, which is supposed to be covered. We’ll see. If you have any Medicare words of wisdom that you would like to share with us Baby Boomers, please do. Either write a comment here on Catching Health or on our Facebook page. (You are a fan of Catching Health on Facebook I hope!)