Kevin Knauss: Health, History, Travel, Insurance
Posts focusing on Medicare Parts A, B, C and D, Medicare Advantage, Supplements, changes in benefits, enrollment.
A health plan without your preferred doctors is not health insurance. Similarly, dental or vision benefits without it being accepted by your preferred dentist or optometrist is just a selling gimmick. Consequently, before favoring a Medicare Advantage plan because of the dental or vision benefits embedded in the plan, it is important to learn about the network of providers and if your preferred doctor is in the network.
There are a couple different ways to structure Medicare coverage. In the absence of any extra help from Medicaid or Social Security for Part D prescription drug coverage, the average Medicare beneficiary will realize the $170.10 for Part B and approximately $35 (national average) for a Part D plan. If the beneficiary adds a Medicare Supplement to cover most of the deductibles, copayments, and coinsurance of Original Medicare, there could be an additional cost of approximately $150 (Plan G in California.) That brings the monthly insurance costs up to $355.
In California there are 32 different Part D plans offered by 11 different insurance companies. One plan sponsor offers six different plans. The only thing that differentiates these plans at first glance are the marketing names like Basic, Choice, Classic, Enhanced, Plus, Saver, Secure, and Value. These monikers are marketing gimmicks and tell the Medicare beneficiary nothing about the benefits of the plan.
Premiums, deductibles, and coinsurance for Original Medicare, 2021. Individuals with Medicare Advantage and Medicare Supplement plans may not realizes some of the higher Medicare costs.
You cannot be enrolled in Medicare and a subsidized Covered California health plan. If you are eligible for Part A of Original Medicare, you are ineligible for the federal and state health insurance premium subsidies. If you don’t terminate your Covered California subsidized plan when your Medicare becomes active, you may have to repay all the subsidy amount you received for those months when Medicare became effective.
Medicare Advantage plans more closely resemble a traditional health insurance plan you may have had from your employer or individual and family plan. They have predictable copayments for many routine health care services such as office visits, labs, tests, and x-rays. Most Medicare Advantage plans include the Part D prescription drug coverage within the plan. For medical services, Medicare Advantage plans have a maximum out-of-pocket amount. Once the dollar amount is met, the Medicare Advantage plan covers all future medical services at zero cost to the plan member.
All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
The great thing about Medicare is that you can build your train the way you want. You can change the train cars every year. But the important aspect is that you own the Medicare engine. You are the engineer and you can build your train the way you want it.
Covered California is expanding its dragnet to catch people who may not be entitled to the Advance Premium Tax Credit (APTC) subsidy. If you are eligible for Medicare, or have other minimum essential coverage (MEC), you are not eligible for the monthly APTC subsidy.
The underwriting holiday only excludes the Statement of Health questionnaire, other conditions may prohibit enrollment. For example, Mary, may have cancelled her Medicare Advantage plan during the Medicare Open Enrollment. Mary suffers from rheumatoid arthritis. With the underwriting holiday, she does not have to answer the Statement of Health questions, one of which is if she has rheumatoid arthritis.
