Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 4 of the series, "New to Medicare." which I'm writing to help guide those who will soon be going on Medicare Parts, A, B, or both for the first time. In Part 2, I discussed how Medicare Supplements and Advantage Plans differ as far as coverage, premiums and Oat of pocket costs, açcess to doctors and hospitals, and how claims are approved and paid. I suggest reading that column again prior to this edition. It and the others in the series can be found on our website along with podcast and webcast versions as well QUESTION: What are the pros and cons of both Medicare Supplements and Advantage Plans? ANSWER: This week will be dedicated to doesn't get talked about much. Supplement insurance companies do not get to make decisions on deductibles on medications with Advantage Plans, Supplements and Part 4 will continue next week when we will do the same with Advantage Plans, what's covered. Medicare lets Supplements, aka Medigap policies and are highly Federally regulated and have been around almost as long as the Medicare program itself. They're designed to It can happen immediately There pick up the portion of the bill not fully covered by Medicare, namely the Part A hospital deductible of $1.484 and the 20% Part B doesn't Supplements don't come with ancillary benefits such as cosmetic dental, hearing, vision, and gym memberships like Advantage Plans. Although Medicare and a Supplement cover medical conditions of the ear, eye, and mouth such as Cataract, Gluacoma, Macular Degeneration, ear infection, eye infection. broken jaw, etc., they do not cover cosmetic services such as teeth cleanings, fillings, root canals, routine eye and hearing exams, glasses, hearing aids, ete. Another negative of Supplements Is six months after one's initial Part Beffective date, these companies use Medical Underwriting to determine if they will accept someone into the patient's treating physician determine what is medically necessary. If your doctor wants you to have an MRI or a surgery, are no prior authorizations or need to wait for an approval before receiving services. In addition, if a doctor thinks it wise for a patient to stay an extra day or two in the hospital or Skilled Nursing Facility, there is no interference from an insurance company Medicare lets the doctor steer the ship as I like to say pay The simplicity of how they work, the ease of making one's choice in plan and company, as well as the peace of mind they offer are very nice benefits. Supplements can only be sold with Plan letters labeled A through N There are only 11 choices, nine for those who turned 65 after January 1st, 2000. All plans cover the same exact medical benefits and provide the same access to doctors and hospitals. With very few exceptions, our agency recommends just two letters, G and N, which expose those who choose them to very few bills. The only medical costs those on Plan Gare responsible for is the annual Part Bdeductible of $203. Supplement benefits never change as long as one remains on the same plan letter. In other words, those who choose Plan N and live to be 85 years old will still be paying just their plans. That means current $20 for doctor visits and 850 at the Emergency Room. Those can't be increased. In addition, co-pays for other services can never be added. For example, in five years you can't be told by the company that you'll be forced to pay co pays for MRI's. X-Rays, or hospitalizations. It's great piece of mind to know that now and in the future, there's no prospect for lange medical bills. Be advised that the Part B deductible does increase over time, but very mildly In 2008, my first year in the field, it was $135. That brings us to the biggest negative of Supplements, cost. They generally have higher premiums than Advantage Plans. starting at $75 to $100 per month for a 65-year-old, depending on zipcode, gender, and marital status. They increase as one ages. I mentioned living to be 85 years old. Those who do can expect to be paying S00 to s250/month or more by that time, not including a separate Part D prescription drug plan, which most on Supplements need to purchase at an additional cost of around $15/month on and previous medical history can keep someone from enrolling. Generally, the only time cne can ever get on a Sapplement, regardless of health is within six months after enrolling in Medicare Part B. This is why it's so important to understand the ins and outs of both types of plans. Although Supplement premiums can never be raised or cancelled on an individual basis, those who start with an Advantage Plan may never be able to enroll a Supplement once diagnosed with certain medical conditions including but not limited to heart disease, oertain cancers, auto immune disorders, A-Fib, Insulin diabetes, and COPD. Plan N has the same deductible and just two small co pays, a physieian's ofice co pay of $0, and an Emergency Room co-pay of $30. God forbid someone has a diagnosis of Cancer and needs scans, a surgery chemo, and/or radiation, etc., there is no worry about getting inundated with bills for those with Supplement Plan Nor G. Supplements provide nationwide access to doctors and hospitals. Not only is there acoess to all health systems here in the Pittsburgh, including our two largest and well known, UPMC and AHN, other world class facilities such as the Mayo Clinic, Cleveland Clinic, John's Hopkins, and MD Anderson Cancer Center can also be used at no additional cost. Fve had several clients whose lives were saved because they were able to get care at these hospitals. Please be advised that my columns and this series are not designed as a substitute for working closely with a licensed agent like those at The Health Insurance Store. The goal is to start the education process, not make a final decision. I recommend everyone call or email us to set up an appointment for a no cost consultation so your individual needs and concerns can be addressed. There is no one size fits all approach when it comes to choosing a Medicare plan. There are many factors that need to be considered before making such an important decision. average. And these Stand-Alone Part D Maybe the number one reason to choose a Supplement in my opinion is an aspect that plans, as they are caled, generally have annual deductibles of $445 for Tier 3, 4, and 5 medications that must be paid before those drugs are covered. There are no 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 4 of the series, "New to Medicare." which I'm writing to help guide those who will soon be going on Medicare Parts, A, B, or both for the first time. In Part 2, I discussed how Medicare Supplements and Advantage Plans differ as far as coverage, premiums and Oat of pocket costs, açcess to doctors and hospitals, and how claims are approved and paid. I suggest reading that column again prior to this edition. It and the others in the series can be found on our website along with podcast and webcast versions as well QUESTION: What are the pros and cons of both Medicare Supplements and Advantage Plans? ANSWER: This week will be dedicated to doesn't get talked about much. Supplement insurance companies do not get to make decisions on deductibles on medications with Advantage Plans, Supplements and Part 4 will continue next week when we will do the same with Advantage Plans, what's covered. Medicare lets Supplements, aka Medigap policies and are highly Federally regulated and have been around almost as long as the Medicare program itself. They're designed to It can happen immediately There pick up the portion of the bill not fully covered by Medicare, namely the Part A hospital deductible of $1.484 and the 20% Part B doesn't Supplements don't come with ancillary benefits such as cosmetic dental, hearing, vision, and gym memberships like Advantage Plans. Although Medicare and a Supplement cover medical conditions of the ear, eye, and mouth such as Cataract, Gluacoma, Macular Degeneration, ear infection, eye infection. broken jaw, etc., they do not cover cosmetic services such as teeth cleanings, fillings, root canals, routine eye and hearing exams, glasses, hearing aids, ete. Another negative of Supplements Is six months after one's initial Part Beffective date, these companies use Medical Underwriting to determine if they will accept someone into the patient's treating physician determine what is medically necessary. If your doctor wants you to have an MRI or a surgery, are no prior authorizations or need to wait for an approval before receiving services. In addition, if a doctor thinks it wise for a patient to stay an extra day or two in the hospital or Skilled Nursing Facility, there is no interference from an insurance company Medicare lets the doctor steer the ship as I like to say pay The simplicity of how they work, the ease of making one's choice in plan and company, as well as the peace of mind they offer are very nice benefits. Supplements can only be sold with Plan letters labeled A through N There are only 11 choices, nine for those who turned 65 after January 1st, 2000. All plans cover the same exact medical benefits and provide the same access to doctors and hospitals. With very few exceptions, our agency recommends just two letters, G and N, which expose those who choose them to very few bills. The only medical costs those on Plan Gare responsible for is the annual Part Bdeductible of $203. Supplement benefits never change as long as one remains on the same plan letter. In other words, those who choose Plan N and live to be 85 years old will still be paying just their plans. That means current $20 for doctor visits and 850 at the Emergency Room. Those can't be increased. In addition, co-pays for other services can never be added. For example, in five years you can't be told by the company that you'll be forced to pay co pays for MRI's. X-Rays, or hospitalizations. It's great piece of mind to know that now and in the future, there's no prospect for lange medical bills. Be advised that the Part B deductible does increase over time, but very mildly In 2008, my first year in the field, it was $135. That brings us to the biggest negative of Supplements, cost. They generally have higher premiums than Advantage Plans. starting at $75 to $100 per month for a 65-year-old, depending on zipcode, gender, and marital status. They increase as one ages. I mentioned living to be 85 years old. Those who do can expect to be paying S00 to s250/month or more by that time, not including a separate Part D prescription drug plan, which most on Supplements need to purchase at an additional cost of around $15/month on and previous medical history can keep someone from enrolling. Generally, the only time cne can ever get on a Sapplement, regardless of health is within six months after enrolling in Medicare Part B. This is why it's so important to understand the ins and outs of both types of plans. Although Supplement premiums can never be raised or cancelled on an individual basis, those who start with an Advantage Plan may never be able to enroll a Supplement once diagnosed with certain medical conditions including but not limited to heart disease, oertain cancers, auto immune disorders, A-Fib, Insulin diabetes, and COPD. Plan N has the same deductible and just two small co pays, a physieian's ofice co pay of $0, and an Emergency Room co-pay of $30. God forbid someone has a diagnosis of Cancer and needs scans, a surgery chemo, and/or radiation, etc., there is no worry about getting inundated with bills for those with Supplement Plan Nor G. Supplements provide nationwide access to doctors and hospitals. Not only is there acoess to all health systems here in the Pittsburgh, including our two largest and well known, UPMC and AHN, other world class facilities such as the Mayo Clinic, Cleveland Clinic, John's Hopkins, and MD Anderson Cancer Center can also be used at no additional cost. Fve had several clients whose lives were saved because they were able to get care at these hospitals. Please be advised that my columns and this series are not designed as a substitute for working closely with a licensed agent like those at The Health Insurance Store. The goal is to start the education process, not make a final decision. I recommend everyone call or email us to set up an appointment for a no cost consultation so your individual needs and concerns can be addressed. There is no one size fits all approach when it comes to choosing a Medicare plan. There are many factors that need to be considered before making such an important decision. average. And these Stand-Alone Part D Maybe the number one reason to choose a Supplement in my opinion is an aspect that plans, as they are caled, generally have annual deductibles of $445 for Tier 3, 4, and 5 medications that must be paid before those drugs are covered. There are no 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents