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Tips for Understanding the Medicare System

Millions of Americans are retiring every year. Retirement should be time to relax, travel and enjoy some of the activities we never had time for while we were working during our lifetime.

Unfortunately, Most people do not realize the maze they are about to go through when choosing health coverage. Years ago, before the days of sky-high healthcare costs, seniors would receive their company pension, Social Security and Medicare, which would usually be enough to live happily ever after.

These days it is not quite that simple. Medicare deducts $93.50 per month from your check for and pays 80% after a $992 deductible. 20% can add up in a hurry. What if you should become sick or injured? What's available to help?

Private Insurance Plans to Help

Medicare Supplement Plans - These plans range in price depending on where you live and the level of coverage but the most popular plans are about $150-$200 per month and usually cover 80% of your co pays.(keep in mind this is without drug coverage)

Medicare Advantage Plans - These plans are relatively new. Generally speaking Medicare Advantage Plans have low or no premiums, lower co pays than original Medicare and may provide extra services that would not otherwise be covered by original Medicare.

There are three basic types of Medicare Advantage Plans

  • HMO You must use a network provider unless except in the case of an emergency.
  • PPO A network plan that allows you to have certain out of network service, with a higher co-pay.
  • PFFS With a Private-Fee-For-Service plan you may use any Doctor or provider that accepts the plans payment. Statistics show that most Doctors that accept Original Medicare will accept a PFFS Medicare Advantage Plan. It is always best to do some research or ask questions on specific plans available in your area.

Time To Choose?

Now all that's left is choosing a plan. That's great but, how do we know which plan fits our needs. The truth of the matter is, depending on the area where you live you may have 30 to 50 or more choices available ranging from $0 to $200 per month. And remember, we're just talking about medical so far not Part D drug coverage. A Few Helpful Tips

1. Start Early - You may enroll 3 months before or after the month of your 65th birthday. It is definitely better to enroll early.

2. Determine which type of plan will work best for you - For example: If you are planning on traveling much you would probably want to use a Private-Fee-For-Service plan so you won't have as many network restrictions.

3. Do Plenty Of Research - It is always a good idea to ask questions and check references. Although most people think a call to the local Office of The Aging is adequate, that is not usually the best way to go. They are not licensed or trained in the field of insurance. The Office Of The Aging is a very good resource to check credibility and sometimes you may find out about local programs or organizations that are helpful if you are in need.

4. Try Some Helpful Websites - Find sites with helpful information. The official site is I have found to be informational. Also, try Center For Medicare Services in your area.

5. Find A Qualified Broker Or Independent Agent - This may be the best way to go. An independent broker will usually represent many different companies. For example: ABC insurance carries Aetna, Blue Cross, and Health Net. Of course this is just an example. A good broker will help you shop and save you time and money.

Michael King CRSP is the owner of Century Benefits Group Inc. Michael is a Certified Retirement Service Professional and a mamber of the NY State Employee Benefits Conference

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