On 4/9/2015 Mmsfoxxie said: This so confusing. I will retire in June so I'm getting ready to talk to an insurance navigator. It sounds like most of you are saying that if your health is pretty good and you don't have a lot of prescriptions then Medicare with a supplement for drugs is fine. Or Medicare advantage which would cover everything. Hmo is fine with me because that's what I've always had.
If you like flexibility and can afford monthly premiums that are perhaps a bit higher, then regular Medicare with a supplement and a Part D drug plan will work regardless of your health history or the number of meds you take. The insurance agency DH and I worked with was able to sit down with us, review the meds each of us takes, and recommend which Part D drug plan would be most cost effective for each of us. They could also explain the costs and coverages, pros and cons of various Medicare Advantage and Medicare supplement ("Medigap") plans. DH and I slogged through all this process last year and feel for others just beginning the confusing journey.
I'd break it down this way:
Medicare Advantage: Simple, everything included under one plan, tight network with limited choices and usually no coverage outside the network, runs like an HMO. If you sign up for one of these, you get a Medicare Advantage card from the insurance plan you join, and that's what you present to providers or facilities when you need care. Your Advantage plan carrier coordinates care and processes/pays your claims. Your Advantage plan is regulated by Medicare, but takes the place of regular Medicare, and you no longer use your Medicare card for medical care. You pay your Medicare Part B premium plus any extra cost (if any) for the Advantage plan. Usually very affordable. Various M.A. plans are offered through a number of providers.
Medicare and a supplement and Part D drug plan: Probably more expensive per month, but much more flexibility. You can go to any provider or facility that accepts Medicare assignment. When you go in for medical care, you present the traditional Medicare card plus your Medicare supplement card. Medicare will process and pay the portion of the expense it covers; the supplement plan picks up the remaining percentage for services approved under Medicare. When you go to your pharmacy, you present the ID card for your Part D drug plan if you opt to sign up for such a plan. You pay for Medicare part B, the monthly premium for the supplement plan, and a monthly premium for the drug plan.
Of course, you also have the option to have just traditional Medicare, pay the Part B premium, let Medicare pay what it will for medical services -- and pick up the rest of the costs out of pocket.
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