Best Medicare Choice?

March 5, 2009 3:45 AM

Too many time-sucking choices--need to cut to the Medicare chase if anyone knows the drill out there.

What are the best, most reasonably priced types of Medicare plans in the alphabet soup for: --a first time enrollee, fit male 65
--great cholesterol, blood pressure, weight
--non-smoking
--oops--the pacemaker (two years old & good for another ten years). Except for pacemaker phone monitoring visits every two months only sees the doctor for checkups.
--has never been on prescription drugs.
--will be living in western Massachusetts
--willing to take high deductible to keep down monthly premiums provided basic preventive care is well covered, i.e. check-ups; recommended tests such as colonoscopies, PSA, etc.
--willing to be in a good HMO and will revisit the decision once enrolled in the best program for a first-timer with this profile.

Bonus question: Can anyone recommend the name of the best network that takes Medicare in the Amherst/Northampton, MA area?

posted by Elsie to health & fitness (5 comments total)

The Medicare site has a little form you can fill out and then it will plug in the most cost-effective choices for you. Then you can ask your doctor or other folks about the top ones it recommends and find out which insurers suck and which ones are good. I found that the low- or no-premium plans tend to be very similar or exactly the same from insurer to insurer in terms of their coverage.

When looking for options for my mom (who, like you, is in good shape generally but has some health issues that need monitoring from time to time) that Medicare Advantage seemed to be a more cost-effective choice than traditional Medicare or Medigap. I also like the fact that you can basically cover parts B, C, and D in one package and not have to deal with so many different insurers.

I will be interested to see others' responses to this question!
posted by phoenixy at 5:50 AM on March 5

My understanding is that you can call them (Medicare) and tell them what you problems you have and they will help you find the best 'provider' for you and your needs, sortof like what phoenixy above pointed out except that you've someone on the inside actually plugging in all the pieces for you. Not sure on this but I think it is the case...
posted by dancestoblue at 7:57 AM on March 5

Elsie:

There's a couple of different things you need to consider when you're signing up for Medicare. It sounds like you're not too familiar with all the ins and outs of the program (not surprising--it's complicated!). The first thing to know is that there are 4 "parts" of Medicare: A, B, C and D. Here's how it works.

Medicare Part A: Hospital insurance (free for you)

Medicare Part B: Medical insurance for all non-hospital costs, like doctors (not free, you pay a monthly premium of about $96)

Medicare Part C (usually called "Medicare Advantage"): A optional managed-care plan that replaces Part A and Part B. It covers everything Part A and Part B do, and potentially other things as well; however, the network of physicians accepting the particular plan is probably smaller. (Like Part B, you pay a premium, but it may be less or more than the standard Part B premium.)

Medicare Part D: Another optional plan for you to sign up for (although one I'd definitely recommend you do sign up for), this is subsidized insurance run by private companies for prescription drug coverage. You'll generally be paying a premium for this as well, although it will vary by how expensive your plan is.

When most people think of Medicare, they're thinking of Parts A and B, which together function just like a regular insurance plan you would get through your employer. You get a Medicare card, and when you call up doctors you just ask, "Do you take Medicare patients?" (Most places do.) When you go to the doctor, you present them your Medicare card, just like an insurance card--because that's what it is, basically a government-run plan. Most people on Medicare stick with Parts A & B rather than signing up for Part C, which replaces A & B.

Medicare Part C and D, on the other hand, are privately-run plans that are partially paid for by the government. Both are optional; you don't have to sign up for a plan, although I'd certainly encourage you to sign up for a prescription drug plan (Part D), because it's heavily subsidized by the government, and if you don't sign up as soon as you're eligible it only gets more and more expensive later. Medicare Part C, on the other hand--the "Medicare Advantage" plans--aren't necessarily a better deal than Parts A + B, which are provided by the government. A lot depends on which company is running the plan. In general, most doctors accept straight Medicare (Parts A & B), but not all will accept your particular Part C plan, so it's important to make sure that the Medicare Advantage plan you might consider includes your regular doctor. On the upside, it may include more services (like hearing aids) that aren't typically covered under Parts A & B.

There's also another type of insurance that a lot of private companies sell called "Medigap" coverage. This isn't sponsored or affiliated with the Medicare program; it's totally private. This type of insurance will cover some of the deductibles you'd face under Parts A and B, for instance if you were hospitalized, in exchange for a regular monthly premium. You definitely don't *need* to sign up for one, although in some cases it can be a good deal, particularly if you like the security of paying a small monthly fee in exchange for not being hit with a big deductible if you're ever hospitalized.

See, there's a reason most people are confused by Medicare--it's complicated! However, in recognition of how complex these decisions are, the government provides funding to agencies in every state to hire counselors that do nothing other than walk people newly-eligible for Medicare through their options. This is probably something you should do; it's free to you, and they will definitely give you the best advice, because they'll knew which plans are a good deal in your neck of the woods, and which ones are rip-offs or scams. In Massachusetts, this program is called SHINE. Their website is here--you should be able to call their number and find out where the nearest counselors to you are. Here's the questions they should help you answer:

*Do I want to stick with Medicare Parts A & B, or should I sign up for a Medicare Advantage plan instead?

*If I sign up for Medicare Advantage, which plan is best for me?

*If I don't sign up for Medicare Advantage, does it make sense to sign up for a supplemental Medigap policy?

*Do I want to sign up for Part D, prescription drug coverage, and if so, which drug plan makes the most sense for me, given the drugs I currently take?

Good luck. I can't help with you with which plans are particularly good, but if you any more questions about how all the parts of Medicare fit together, please feel free to ask.
posted by iminurmefi at 8:55 AM on March 5

Okay, and looking at your specific points below the fold, let me just say that if you are:

willing to take high deductible to keep down monthly premiums provided basic preventive care is well covered, i.e. check-ups; recommended tests such as colonoscopies, PSA, etc.

and

has never been on prescription drugs

Then I think you probably don't want a Medigap plan. (So throw away all the catalogs for AARP Medigap insurance I'm sure they're starting to send you.)

You also probably want the cheapest Part D plan available if you're not currently taking drugs. You can switch Part D plans every year at a specific time, so if you got sick or started needing to take an expensive drug you could always find a better plan in a year--but signing for SOMETHING now means that you'll always receive the lowest-cost plans, rather than having to pay a higher premium later because you delayed signing up until you needed it. You can find the Part D plans available in your area through this plan finder on the Medicare site. If there's one option that is cheaper than all the rest (probably because it covers the fewest drugs), that's probably the one you want to go with.

If you're okay with paying higher deductibles in order to keep your monthly costs low, I imagine that sticking with Part A & B might be a better choice than Medicare Advantage coverage. However, talking to the people at your local SHINE office will confirm this--there's a possibility that the monthly cost for one of those plans may be cheaper for you.
posted by iminurmefi at 9:05 AM on March 5

Thank you so much, everyone, for providing so much helpful information, esp. iminumefi.
posted by Elsie at 2:54 PM on March 5