We don't charge any fees to help you find a plan. You pay the same for a plan whether you use a Medicare broker or not. If you don't use a broker, the insurance company keeps the money they would use to pay brokers. It does not cost anything to use our services!
Medicare Advantage Plans
Medicare Advantage plans and Medicare Part C Plans are two terms used interchangeably. They are the same thing. These are usually the plans that you see advertised all over the TV and the ones who send you large amounts of mail. Medicare Advantage plans are designed to give you a lower premium option and have copays for almost everything you do at the doctors office.
I think of them as pay-as-you-use it plan, because you usually have a smaller premium when compared to Medicare Supplements, but you get a bill for almost everything you do at the clinic or hospital. Most plans do not have a deductible and the copays are reasonable when compared to plans before turning 65.
These are also the plans that usually offer all of the bells and whistles like: dental, vision, gym memberships, and hearing benefits. We tell everyone to pick a plan based on how it will cover on heart attack and stroke vs. how it will cover bells & whistles.
Medicare Advantage plans have a network and if you receive services outside of your network, you will usually pay more. These plans are similar to health insurance plans that you may get through work before turning 65.
You sign up for a plan like this through an insurance company and not Medicare directly. Each company and plan submits their proposals to Medicare and then Medicare approves them to offer the plans. So if you chose a plan like this, Medicare will pay the company you chose to administer your benefits each month, which is why plans can start as low as $0/month (Keep in mind you will still pay your Medicare Part B premium).
If you move to a new county, you will usually have to chose a new Medicare Advantage plan if they do not offer that same plan in the new county. These plans usually change between counties. If you move to a new county, you will have a 60 day enrollment period before or after your move to sign up for a new plan.
Advantage plans change each year. Advantage plans may come with drug coverage - called MAPD (Medicare Advantage Prescription Drug), or they may come without drug coverage (Medicare Advantage). Most people that take a plan without drug coverage are veterans because they get their drugs from the VA.
You can change your Advantage plan October 15th-December 7th of each year, and the new plan would start January 1st. They do not ask any medical questions.
At Health Insurance Advisors, LLC we send our clients letters every fall reminding them it is their time to look at changing plans. We help them research the top insurance companies & plans for each individual client and meet with them to go over our findings. We are like personal shoppers in the Medicare world.
Medicare Savings Accounts
These plans are the newest type of Medicare plans. They work a lot like Health Savings Accounts do. Their monthly premiums must be $0/month by law. Then, the plan you chose deposits a certain amount onto a card when the plan starts. You can use that money for all medical services. Things like clinic and hospital visits will count towards your deductible and out-of-pocket-max. You can also use the money for dental, vision, and prescription drug copays, but those things do not count toward your deductible/out-of-pocket-max.
After you use the money that was deposited, you will have a gap where you will be responsible for all costs until you reach the deductible/out-of-pocket-max.
If you don't use the money that is deposited, the money accrues and rolls over each year. If you leave the company, you can take the money you have accrued with you.
These plans have no network and you can go anywhere Medicare is accepted. If you chose a plan like this, you must chose a separate Medicare drug plan. Prescription drug coverage is not included in this type of plan.
Medicare Savings Accounts are actually a specific type of Medicare Advantage plan, but they are so different we had to explain them in a totally separate section.
Medicare Cost Plans
These plans are only available in certain counties: Aitkin, Carlton, Cook, Goodhue, Itasca, Kanabec, Koochiching, Lake, Le Sueur, McLeod, Meeker, Mille Lacs, Pine, Pipestone, Rice, Rock, Sibley, St. Louis, Stevens, Traverse, Yellow Medicine. Some exceptions may apply. Counties are subject to change. Eventually these counties will also lose cost plans as an option for a Medicare plan but we have no idea when that time will be.
Medicare Cost plan plans are like the in-between of a Medicare Advantage plan and a Medicare Supplement, because they have some of the same characteristics as them. They have no network like a Medicare Supplement, but they do have more copays and coinsurances, like a Medicare Advantage plan. They also offer bells & whistles Medicare Advantage plan.
Some Medicare Cost plans include Prescription drug coverage and some do not. If you chose a plan that does not include prescription drug coverage, you can purchase a separate prescription drug plan (PDP).
A Medicare Cost plan changes each year. They adjust their copays, coinsurance, max-out-of-pockets, and premiums. A Medicare Cost plan is actually a specific type of Medicare Advantage plan, but it is so similar we had to give them their own section.
These plans offer the most comprehensive coverage. They are usually higher in price. They have no network, so as long as the facility takes Medicare patients - they will take your plan.
If you sign up for Medicare after January 1st, 2020 - you can not get the Part B rider. Which means that you will pay a $203 yearly deductible (2021). They are the most comprehensive in how they cover you in the hospital and clinic, but offer very little bells & whistles like: dental, vision, hearing & gym memberships.
You can keep these plans when you move. If you move to another county or state, you can keep your plan and many times - you can keep the premium you are paying as well. These plans do not include drug coverage, so you would have to enroll in a separate prescription drug plan.
You have 6 months to chose a Medicare Supplement after going on Medicare Part B. If you want a Medicare Supplement after 6 months, you will have to pay a health questionnaire (go through underwriting) to get on a Medicare Supplement.
Medicare Drug Plans
Medicare Drug plans, Prescription drug plans, Rx plans and PDP plans mean the same thing and the terms are used interchangeably. These plans are also run through private insurance companies but are approved by and overseen by Medicare. Therefore, you do not sign up for a plan through Medicare, but through an approved company instead.
If you do not sign up for this when you are first eligible and if you do not have other prescription drug coverage as good as, or better than Medicare - you will get a penalty. You will accrue this penalty every month you go without drug coverage. You will start paying this penalty every month for the rest of your life after you sign up for a drug plan. The penalty is 1% of the average drug plan rate in the year you sign up multiplied by every month you went without a plan. That amount is then added to your premium each month.
Drug plans have formularies and coverage each drug differently. Each company and plan comes out with a new formulary each year. Health Insurance Advisors, LLC can help you do the research and find the most cost effective plan for you.
You can change your drug plan October 15th-December 7th of each year, and the new plan would start January 1st. If there is something called a 5-Star Drug plan, then you can change to that drug plan any month throughout the year. There is not a 5-star Drug plan every year.
The information on this website is for educational purposes only. While we have taken every precaution to ensure all information is accurate, errors can occur. Health Insurance Advisors, LLC assumes no responsibility for any errors on this page. Sources: Medicare.Gov & SSA.Gov