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Some helpful tips about enrolling in Medicare

by Robert Randle
03/01/17
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When a person approaches retirement age a flood of information suddenly and unexpectedly starts appearing in the mailbox, as well as unsolicited calls from insurance companies and independent brokers regarding the best Medicare plan on the market. This is even more relentless than AARP membership offers that end up in the mailbox among other junk mail flyers. Since I have already enrolled in Medicare I felt it might be useful to share my experience with those who already are enrolled in a Medicare plan or are about to at some point in the future. The first thing I recommend is to order the free booklet, “MEDICARE & YOU” from the Department of Health & Human Services Medicaid & Medicare Services at 1-800-633-4227. The booklet will show what services are covered under Medicare as well as some of the Medicare Advantage plans that are available in the state in which you live.

Now here is what you need to know: If you decide to enroll in a Medicare Advantage Plan (MAP) you will have to pay a monthly premium under this plan in addition to having a Medicare Plan B premium deducted from your Social Security (p. 17).  Now here is the real eye-opener: A Medicare Advantage Plan (HMO, PPO, etc.) is offered by “private companies” that are Medicare-approved by the U.S. Department of HHS and the administration of these services are set by government rules. If you elect a Medicare Advantage Plan (MAP) you get Medicare Part A (Hospital) and Part B (Doctor’s) coverage but it is “NOT ORIGINAL MEDICARE” as administered by the federal government. Additionally, it is not a supplemental plan because when you enroll in a MAP you are essentially dis-enrolled or “NOT” covered under ‘Original Medicare” and as such, you have to meet different deductibles, co-insurance/co-payment limits, and whatever else.

Perhaps the only real ‘Advantage’ in a MAP is that you have a yearly out-of-pocket maximum limit (p. 69), whereas under ‘Original Medicare’ there is no upper limit for annual out-of-pocket costs (p. 64). As with anything of value it is good to get as much information as possible before you choose the best plan for your needs. Contact MEDICARE and ask the representative to give you the cost of your annual deductible for Original Medicare part A (Hospital) and also for part B (Doctor) charges. The one thing that I found puzzling is that if I enroll in a MAP and pay premiums then why part B payments still are being deducted when I am no longer covered under Original Medicare, but when I asked this question all the person on the line did was continue to repeat that I have to have parts A and B to enroll in a MAP; which to me was not a real answer but rather the usual- you know what I mean.

Interestingly, there are no “Medigap” plans listed in the book (at least, for WA State) but quite a few Medicare Advantage plans, and Medigap is actually a supplemental plan because when you enroll in one you are still covered under Original Medicare, too. The thing is though; the premiums are usually quite a bit higher in some cases than either a MAP or Original Medicare but the annual deductibles are a lot lower in most (??) cases. When considering either plan outside Original Medicare try to find out if the annual out-of-pocket costs include deductibles, co-payments, co-insurance and/or other fees to determine if you are getting the most bang for your buck. This is your body and health needs and it doesn’t take a Rocket Scientist, having a representative or independent agent from one of these agencies contacting you, or attending a workshop to choose a plan; the good thing about all of this is you can always change your mind if you learn something else is better, and opt-out within the enrollment period. At the very worst, you can just wait another year and try another plan or remain in Original Medicare.

Robert Randle
776 Commerce St Apt 701
Tacoma, WA 98402
March 1, 2017
[email protected]