Medicare Information : Critical

Health Insurance Education for Lee and Collier County Seniors

We will not attempt to re-create the basic Medicare information. There are plenty of resources, starting with the official (  Medicare is great, but as about everyone who has ever used it knows, it has many “gaps” in coverage. To say the least, it does not cover everything. For starters,  if you need to be admitted to the hospital, there is a deductible of $1,184 you are responsible for. Then if you need to see a doctor, before any “doctor” fees are covered, you have another deductible ($147), and after that, you are only covered for 80% of the allowable charges and your 20% has no ceiling or cap on it.

In addition, Basic  Medicare does not cover prescriptions you have filled outside a hospital.

Again, there is plenty of information in addition to the official and basic medicare information site, and it’s generally provided by insurance companies.

As you would expect, different companies treat insurability coverage in different ways, and virtually no company has all the contingencies

Most people only see or talk with agents of one or two companies and then these agents, when working  for a certain company (as most agents do) are first not going to tell you of the options that their competitors offer that they don’t… .even if the competitor policy would work better for you. Fact is, they might not even know the competitor line and even if they did, if they are not appointed as a sales agent for the competitor company.. they are not even   allowed to tell you as it would imply representation.

So what is a person to do?  In a word, get educated on medicare insurance company offerings. Now this is not as easy as it sounds, because you may not even be prepared to know what questions to ask!

Here’s a starting point: Ask yourself: “What is the purpose of health insurance.. or insurance in general?”   The answer is that health insurance is here to protect one’s financial assets from sudden and unexpected financial disasters.  And what might those be?  These are things in the critical illness family such as cancer, stroke, heart attack, kidney failure and the sort, or from accidents.

Insurance is often thought of as to cover things like doctor visits, tests, etc. This is not insurance.. it’s essentially the prepayment of things that ARE expected and not necessarily sudden.   As we age, we EXPECT that we are going to have more frequent doctor visits; more frequent prescriptions, and more frequent tests.

Can insurance help pay for these?  Sure, but you are going to have a share of those costs one way or the other.

So this is what you need to do: Once  you review and understand what insurance is about, you start about evaluating what the various options would cost  you in a “bad medical year”. In other words, you are preparing for the worst case situation. Again, this is what health insurance is about.

Think about and write down what your worst case health year might be. Not the year you had last year if you were healthy; not the year you hope or expect to have with maybe just a couple of tests or doctor visits to check  you blood pressure medicine or cholesterol prescription. What would a worst case year be?

OK.. now you look at the two general families of insurance for seniors: Medicare Advantage Plans and Medicare Supplement Plans.  You want to see what your probable out of pocket would be in a worst case year  with these two general categories.

But now you run into a road block, because while you recognize the categories, you can’t name the plans because….. you have only been provided the information on maybe the pricing and costs from “Company A” and or “Company B”   OK, you are a shopper.. so lets say also “Company C”.

Some Medicare Supplement Concepts to know

When it comes to Med Sup comparisons… the task is relatively easy (or so you think) because you have learned that the benefits from each company for each plan are totally identical and standardized. It’s the law!   But here’s what maybe you did not know: Not every company has to offer every plan, and when they do, they are free to charge and set their own rates!

Many people are “sold on the idea” of choosing a lower cost plan N than an F because they know they can change plans. Sure.. IF… (1) You are not so ill or incapacitated when you need the    F that you can’t make the change, and (2) If the insurance company will let you without regard for pre existing.

But had you ever heard of the High Deductible Plan F and how to use it to totally reduce costs?

HINT: This is one thing you need me for because I represent most major Medigap companies and can help you in the education process. Note I did not say the “buying ” process. We are quite well regulated as to “selling” or pressure. But we are also charged with the senior ethics responsibility or providing the best help, education, and training to enable our clients to make the decision best for them.. and without a good base of information, you can’t possibly do this. You need me, or another experienced, ethical, and senior agent to help you.

Evaluating Medicare Advantage Options

First, we should be aware of the total annual max out of pocket costs, and we think of the whole body, so we must evaluate not only prem options and copay options but the value added benefits offered by a plan. These range from gym memberships to cash reimbursements to OTC drug benefits. As long as a Medicare Advantage plan covers all A and B mandated requirements, there’s no limit as to what else they can give! But “give” is a misleading word, for to “get” you probably are giving up something. Do you know what it might be?

As agents, we can only discuss benefits of companies we are authorized to represent and we can not even solicit your business! In many cases, we are not allowed to voluntarily even give you a business card!  But you can contact us and ask us for an appointment, but it has to be YOUR choice. We can teach these rules but not ask for  your businesses, make a call to a referral or anything.. Supposedly this protects seniors from harassing sales calls, and maybe it does, but it makes you responsible for getting and absorbing information.  I happen to know an agent who is responsive to requests and he’s the webmaster.

Well, this should give you an idea. If  you have any questions about the learning and education process, as well as what we can do for you, please contact us.

4 thoughts on “Medicare Information : Critical

    1. admin Post author

      Will be happy to help. Please contact mw with help want details. Joe, 321 821 5394 or 561 214 4709


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