MEDICARE: Making Sense Out of the Plans

Palm Beach, Palm Beach County, 09/28/2012 / SubmitMyPR /

Medicare — it used to be pretty simple. You turned 65 and that was it, you were covered, at least for the most expensive health costs. But now Medicare has expanded and offers a number of options so you can tailor your coverage to suit your needs. But how do you choose?

Because age 65 is looming for both my husband and me, I realized I had better start looking into this. I’m glad I did.

I had read in The Wall Street Journal that, when it comes to shopping around for the best plan to supplement your Medicare benefits, it’s best to avoid going to an insurance company-specific broker or insurance company-sponsored service, as “you probably won’t get a review of every option open to you.” That, I thought, made sense.

So I turned to Noel Wallis, an independent insurance professional who is licensed in not just one but ten states, Arizona, California, Connecticut, Florida, Iowa, Nevada, New Jersey, New York, North Carolina and South Carolina. Wallis has helped me in the past with various insurance decisions and, because he is an independent agent, he is not limited to recommending plans offered by only a select number of insurance providers.

There are two components to the basic Medicare, Wallis explained. The first is Part A, which covers inpatient hospital stays, nursing facilities, hospice care, and certain types of home health care. Part A has little or no monthly premium cost to you, depending on how much you contributed through pre-retirement salary. The second is Part B, which covers doctor visits, some physical and occupational therapy, and general preventive care. Participation in Part A is automatic; you must sign up for Part B, however, if you want any form of supplemental coverage, and it’s a good idea to do so before you turn 65. There are varying enrollment periods, Wallis said, so doing your homework and making informed choices before you turn 65 is the smart thing to do.

It’s here, Wallis said, where figuring out what covers your situation best can be confusing and why it’s good to have an independent advisor, like Wallis, help you determine what will work best for you. “There are just so many choices.”

“No choice is permanent,” Wallis pointed out, so if my husband and I wanted to change our coverage for any reason, such as if we moved house to outside our plan coverage area or suddenly required what is known as a dual SNP (Special Needs Plan) available for diabetics, dialysis patients, etc. He advised me we’d have to be eligible for either Medicare or Medicaid in order to get such a plan.

The real challenge for me was going to be deciding just what supplemental plan would be right for my husband and me. I was grateful to have someone to break it down for me based on my individual needs as, frankly, I found it all a bit confusing.

To start, Wallis advised, I needed to discuss our personal circumstances in order to get the kind of coverage tailored to our needs for the least amount of money. He started asking questions, lots of them.

Part D is the supplemental prescription drug benefit. It is not mandatory and it does come at an additional cost, as it is provided by private insurance companies, not the government. Those opting for Part C, called the Medicare Advantage Plan or Medicare Complete, receive a complete coverage package that already includes prescription drug coverage.

Are you okay with an HMO or is your doctor not part of one? You might prefer a plan that allows you the freedom to choose your doctors and hospitals. Medicare Advantage is not exclusively HMO-oriented, as some might think. There are PPO (Preferred Provider Organization) plans available as well, where you can opt to go outside of a network without the need for a referral. There may be a slightly higher co-pay if you go out of network, but I was pleasantly surprised to learn that a lot of Medicare Advantage providers offer these PPO options.

“Consulting with someone with real insight into the insurance market is also a good idea,” Wallis said, “because you might be weighing two plans that are essentially identical but one has a slightly lower premium. Why pay more for identical coverage?

“The bottom line is that you want to make the most informed choice possible, because the most informed choice is the best choice,” Wallis advises. I couldn’t agree more.


For more information feel free to contact:
Noel Wallis
Wallis Financial Group, Inc
7724 Royale River Lane
Lake Worth, Fl 33467
Phone: (561) 963-2467 Fax: (561) 963-2468 Cell: (954) 328-7110
Email: [email protected]; [email protected]
Licensed in Florida, New York, New Jersey, Connecticut, Nevada, California, Arizona, Iowa
North & South Carolina
License# A276734