Carpenter Insurance provides health and life insurance, senior plans, annuities and financial products in Wimberely Texas and throughout central texas.

Senior Plans

MEDICARE AND 4 PATHS YOU CAN TAKE

As a person approaches Medicare eligibility, some very important decisions have to be made about the different paths one can take with their health insurance.

Here is a road map (so to speak) of what this looks like in its simplest fashion. But first, here are some important keys to understanding this map.

Medicare is made up of 4 Parts. A – B – C & D. Here is a brief explanation.

Part A: Inpatient Hospital and Skilled Nursing Facility coverage. (think buildings)
Part B: Inpatient and Outpatient Medical expenses. (think people)
Part C: Medicare Advantage – like HMO’s PPO”S, Special Needs Plans etc.
Part D: Prescription Drugs (retail and mail order)

Remember this formula: Parts relate to Medicare and Plans relate to Insurance.

Medicare = Parts & Insurance = Plans

It all boils down to Parts and Plans getting matched up properly to suit your needs.

A call to the Social Security office can help you find out what Parts you are eligible for.
Here is their National # 1800-772-1213. Once it is determined that you are eligible for Parts A and/or B, your journey can begin. None of the insurance Plans (except group) are available to you if you do not have Part B. All of the special dates and time lines hinge around your Part B eligibility date.

From my view – here are the 4 Paths you can take regarding your overall healthcare choices.

Path 1 – Original Medicare A & B – ONLY.

You would be self insuring for expenses not fully paid for by Medicare A&B. You can also carry your Part D plan as a separate policy. This is highly risky. Not advisable at all.

Path 2 – Medicare Part A and your Group coverage if any.

If you are still working and covered by your employer, you may be better served to stay where you are. Your human resources department or myself can assist you with this decision. An example could be Part A and group health which normally includes Part D.

I have seen all kinds variations. Deferring Part B until you retire still allows you to have your 6 month open enrollment period that starts on the 1st day of the month your Part B starts. You could then get a Supplemental Plan and a stand alone Part D (Path #3) or go to a Part C plan that includes Part D – (see Path #4). It is very important to know the facts so you choose correctly whether to take Part B now or defer.

Path 3 – Original Medicare Parts A&B, plus a private Medicare Supplemental Insurance Plan (like Plan F) (sometimes called a Medigap Plan) – plus a Stand Alone Part D Plan (sometimes called a PDP – prescription drug plan).

There are several plans and carriers to choose from. Note this one important fact – ALL SUPPLEMENTAL PLANS ARE EXACTLY THE SAME IN BENEFITS. They identified by a Letter such as Plan F – which happens to offer the most in benefits. A Plan F is the same in benefits – nationwide among all carriers. They do however vary greatly in price, and who you have to go through to get it.

We strive to offer the best ones at the best rates for you and your area. I have seen this path work out the best for most people over the years. You are in charge and will have the most amount of freedom. With this choice – you can go to any doctor/hosp anywhere in the USA that will treat a person that has Medicare A and B. Hence – Medicare is primary and your Supplemental Plan is secondary. Your coverage is guaranteed renewable for life. You can cancel anytime – apply with a different carrier (insurability may be required) at anytime etc. etc. This is what the majority of our clients own. We can shop rates for them every year, 2 or 3 etc. There are NO annual enrollment/dis-enrollment deadlines.

With this combo - you will carry your own Part D prescription drug Plan (PDP) that will always be separate from your supplemental Plan. You can change your PDP plan yearly if you want without evidence of insurability. We usually offer the top 2 carriers and their 3 plans each.
Just ask for a quote and see if this suits your taste.

Path 4 – Part C Medicare Advantage Plans.

The first thing to understand about this path is that you will NOT be covered by Medicare A & B. You will however still pay the Part B premium. You and the insurance carrier/healthcare system will be totally responsible for your heath care liabilities.

There can be several choices of Plans offered to you, depending on your county. Plans such as: HMO's (Health maintenance Organizations), PPO's (Preferred Provider Organizations), PFFS (Private Fee for Service), SNP (Special Need Plans) etc. Most of these plans include Part D coverage as well. Some of the Plans offer great benefits - some with low or zero premiums. I have seen them work well in the areas where you have a tight cluster of doctors, clinics, hospitals, labs etc that are all in agreement and on contract with the Plan. I have also seen then NOT work well in rural areas. They work great some places and some not.

Let me caution you on something. Always remember that ZERO premium does not mean ZERO cost. Cheaper is not always cheaper. These plans can have some large out of pocket maximums (every year) that you may have to pay out of your own pocket before they take over at 100%. Remember that Medicare A and B are NOT in the picture when you sign up for Part C. Don't be lured into enrolling in one of these plans due to their low rates and side benefits (like memberships to health clubs and limited dental and vision benefits) until you have done ALL of your homework and checked out all other options.

Also, should your Part C plan cancel their contract with the government or should the government cancel their yearly contract with your Part C Medicare Advantage Plan - you will loose your coverage and will have to find another plan. This will also happen if your Plan decides to cancel your county. You basically rent the coverage. If you happen to move out of their service area – you could possibly lose your coverage if the county you move to is not offered there.

If this happens to you, you can get on another plan (if another is offered in your county) or go back to Original Medicare A & B and then enroll in a Supplemental Plan. There is no insurability requirement if you act within 63 days. Same goes for Part D.

Why am I being so cautious? Once you take this path – you will have restrictions on how and when you can exit to either another Part C Plan or reroute back to Original Medicare and possibly a supplement. Know the details and make 100% sure that your doctors accept your Part C plan. This is very important. Do not assume anything.

So, there you have it – 4 different ways to go – each have their pros and cons. There could be another path or two out there. I have given you the scoop on what I have seen and deal with on a day to day basis in Texas. This information is in condensed form to educate you.

Now, you have one more choice to make. Do you sift through stacks of solicitations that you
are receiving or soon to be receiving and then try to figure this out on your own – hoping to make the best choice? Or, do you ask for guidance from an expert like myself?

We specialize in helping people just like you get started on the right path and stay on the right path all along the way. I have been doing this one-on-one since 1983. This is one of the reasons why we are blessed to have loyal clients that have been with us over 20 years and counting. We know what we are doing and will not steer you wrong.

Hopefully, we will hear from you soon.

Sincerely,

Carlton Carpenter