Signing Up For Medicare in Meridian Idaho

Medicare Sign Up 2018

The window is now open: 15 Oct – 7 Dec 17. For all Medicare eligible patients, the new enrollment period is here. What does that mean? Time to perform a checkup on your plan and see if you want to change or continue with your current plan (knowing that included coverage benefits are OFTEN altered from year to year).

 

Basic Terminology: Great Primer on (https://www.cnbc.com/2017/10/10/if-you-miss-this-medicare-deadline-it-could-hurt-your-health.html)

 

  • Medicare A: Hospital service coverage
  • Medicare B: Medical service and supplies coverage (outpatient care, doctor visits)
  • Medicare C: (Advantage Plans): Offered by an insurance company, combines A+B and usually covers D
  • Medicare D: Prescription drug coverage (optional), Must purchase separately if use A+B
  • Medigap Supplemental: Optional gap policy to cover items not included in A+B

What plans are available in Idaho?

 

Medicare offers a listing @ https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html

Also, http://www.medicarehelp.org/2018-medicare-advantage/county/ada?state=idaho

 

US News and World Report lists local Treasure Valley plans by highest to lowest rated @ https://health.usnews.com/medicare/search?county=16001&type=cd&zip=83646&sort=rating

 

Free help is available from the Idaho Department of Health and Welfare SHIBA division @ http://www.doi.idaho.gov/shiba/default.aspx or call them at 1-800-247-4422.

A detailed guide from Idaho is here: https://apps.doi.idaho.gov/DisplayPDF?Cat=Shiba&ID=2017%20Shoppers%20Guide&Type=pdf

Key considerations on selection include

1) monthly premiums (amount spent every month even when services are not needed)
2) deductible (amount you pay before the insurance company begins to pay anything)
3) max out of pocket (most you will pay for A+B services; does NOT include D costs)

Although some assistance is provided by the insurance payer for “preferred” medications, as defined by the payer, a coverage gap (donut hole) commonly will apply. For example, you will often see the following qualifier:

“In 2018, once you and your plan provider have spent $3750 on covered drugs, (combined amount plus your deductible) you will be in the coverage gap. (AKA “donut hole”). You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. (VERY uncommon)”

These high copay amounts will apply through the donut hole time until the max out of pocket is reached.

If you KNOW you will need substantial medical coverage in the upcoming year, it may be wiser to pick a plan that may have a higher premium, but has a lower max out of pocket.

Another consideration is how restrictive each plan is regarding prior authorizations and limits on which services/medications are readily accessible. Ask your physician for which payers cause them the greatest grief and difficulty in having services approved to help you.

Seven tips to help you pick a plan from the Huffington Post are here: https://www.huffingtonpost.com/bob-rosenblatt/medicare-advantage-plans_b_4275652.html

Medicare A+B vs Medicare C (Advantage)

Original Medicare A+B is going to be more expensive. Medicare Advantage is going to be less and typically covers more; some plans have vision, dental and hearing coverage. A few even have zero-dollar premiums.

However, you need to look at your health care needs and lifestyle preferences to decide. If you travel frequently or you’re a snowbird, Medicare Advantage plans often won’t cover you when you’re out of your geographic area due to narrow networks with greater restrictions.

You cannot get something for nothing; lower costs with Medicare Advantage may give less flexibility on which doctors and hospitals you can use.

Medicare and Medicaid

Some individuals with special needs qualify for BOTH Medicare and Medicaid. Using original Medicare A+B can be VERY problematic for you. For example, the Medicare contractor in Idaho – Noridian – may require drug “A” for a given condition while Medicaid requires drug “B”. If each refuse to cover the other medication, then the patient ends up with NEITHER agent.

 

A very helpful solution to this dilemma is a Medicare Special Needs Plan. These plans create a single set of rules by combining benefits from both Medicaid and Medicare. This GREATLY helps your doctor take care of you.

We strongly suggest that ALL patients with both Medicaid and Medicare select this single plan option to avoid conflicts created by the differing benefit plans. In the Treasure Valley, two options exist:

2018 Medicare Special Needs Plans in Ada county Idaho

 

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