Medicare is a complicated subject. Often, there is anxiety over trying to determine which supplement plan type to choose. Clients have said, “I feel so incapable of understanding all of this.” Much like you hire a CPA/accountant, to help you with taxes, it’s a good idea to hire Benefits of Nevada/Traci Hutchinson to help you figure it out.
Traci/Benefits of Nevada is an independent agent/broker with 17 years experience, who provides professional and expert level knowledge and information. Contact Traci and she will provide you with a consultation (she breaks it down to simple and easy-to-understand information) to help you choose a plan/policy from approved, top-rated carriers.
Note: Benefits of Nevada services Utah, Arizona, California, Nevada
|Medicare Supplement Plans: Also known as Medigap plans, these are insurance plans provided by private health insurance companies. The plans work with Original Medicare (Parts A & B are primary, and a supplement is secondary). They help pay the out-of-pocket health care costs under Original Medicare (such as deductibles, co-payments, coinsurance). Depending on the plan, it may also offer some coverage for travel outside of the US.
Standardized plans sold after 2010 are titled “A – N” and must follow federal and state laws (designed to protect you). No matter if you buy your policy from one carrier or another, the policies sold, must provide the same benefits. Some differences among insurance carriers typically includes monthly premiums, how they do rate increases, and plans available. The most coverage available is under Plan F (covering Original Medicare deductibles and coinsurance).
Neither Original Medicare nor the supplement offer prescription coverage, so you will need a stand-alone prescription drug plan (Part D).
Eight Additional Points to Know:
1. You can enroll in an HMO, Special Needs Plan, or PPO in Nevada (other plan types exist in other states).
2. Your Medicare is still active; however, providers bill the insurance company instead of Medicare. Note: If this is the plan you have, you will only take your Medicare Advantage card with you to a provider (keep your Original Medicare card (A&B) in a safe place).
3. You typically use providers contracted with the insurance carrier.
4. Medicare pays a fixed amount to the insurance carrier offering the Medicare Advantage plans. Those offering the plans must follow the rules set by Medicare. However, each plan can charge different copays (out-of-pocket costs).
5. In addition to your Part B premium, you may have additional premium to pay for these plans.
6. You can only enroll in a plan at certain times. In most cases, you’re enrolled in the plan for a year. Open enrollment is October 15 – December 7, with plans becoming effective January 1 of the following year.
7. Plans run from January 1 – December 31, and benefits, premium, etc. can change each year. Be sure to review the Annual Notice of Change (ANOC) provided by the carrier for any changes.
8. Providers can join or leave a plan at any time during the year. It may be necessary to select new providers when that happens.
Health Maintenance Organization (HMO): Enrollees must use only network doctors and hospitals in the plan’s service area, except in emergencies (emergencies/urgent care covered worldwide). Enrollees must typically choose a primary care doctor and may need a referral to specialists.
Special Needs Plans (SNP): Plans offer specialized health care for specific groups of people (i.e., chronic conditions, those with Medicare and Medicaid, and living in nursing homes).
PPO (Preferred Provider Organization): Enrollees generally get care from any provider in the US who accepts Medicare, but will pay less if they go to “preferred” providers in the network. Enrollees do not need a referral to see specialists.
1) Enroll in a stand-alone plan (needed if you are choosing a Medicare Supplement/Medigap plan).
2) Enroll in a Medicare Advantage plan with prescription drug benefits included.
Low Income Subsidy (LIS): Assistance provided through Social Security to help pay for prescription medication. You could apply if your annual income is up to $18,090 ($24,360 for married couples), and have up to $13,820 ($27,600 for married couples) in resources. Call Social Security to apply at: 1-800-772-1213.
If you don’t meet these qualifications, you can also contact the State Health Insurance Assistance Program (SHIP) for more info.
Senior RX: Nevada’s assistance program for prescription copays during the Part D “Coverage Gap/Donut Hole.” For more information and how to apply visit: http://adsd.nv.gov/Programs/Seniors/SeniorRx/SrRxProg/
The Missing Pieces
Dental/Vision: Original Medicare doesn’t provide dental/vision. Please click here to learn more about coverage options.
Travel: If choosing a Medicare Supplement/Medigap plan, there are still out-of-pocket risks. Please explore the travel plan options we can provide.
Cancer: “Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them. “ – Medicare.gov
If you would like to look into coverage to help with out-of-pocket, you can explore supplemental plan options here.
Long Term Care: “Many people think the phrase “long-term care” refers to an insurance policy. While insurance may be part of your strategy, long-term care encompasses everything from long-term services, support and finances, to where you will live and how you will navigate the myriad of legal, family, and social dynamics along the way.” – https://longtermcare.acl.gov/the-basics/index.html
Defined as a “range of support for your personal care needs. Most long-term care isn’t medical care, but rather help with basic personal tasks of everyday life, sometimes called activities of daily living (ADLs). “ –Medicare.gov
If you wish to consider insurance as a means to cover Long Term Care, let us help you explore the options available.