MEDICARE & MEDIGAP OPTIONS 2012

This article is about Medicare Options in 2012, specifically for Montana, written by Duane “Pete” Pettersen. For anyone in the USA interested in learning more about options in your state, please refer to www.medicare.gov and to the CMS (Center for Medicare and Medicaid Services) publication, Medicare & You which is sent out to all people age 65 or older. For Medicare Supplement or Medigap policies, CMS puts out an excellent summary called 2012: Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

Original Medicare Only

Part A:  Hospitalization.

Paid for by payroll tax.  $1,156.00  deductible for 2012.

Part B:  Medical.

Minimum Premium of $99.90 deducted from one’s Social Security check.

B has a $140.00 deductible in 2012.  Medicare approves about 80% and pays 80%  of what they approve.  Example: If you get a $100 bill,  Medicare would approve $80 and pay $64.  You are responsible for 20% or $16.00. 20% of an outpatient surgery could mean significant costs.

Medigap or Medicare Supplement Policies

Designed by private insurance companies to fill the GAPS of Original Medicare: The A & B deductibles and the 20% gaps.  About 20 companies offer Medigap F and other GAP policies in Montana.  Premiums range from about $115 a month for one aged 65 to about $190 for one aged 90.  All benefits of GAP policies are set by Medicare (CMS) thus you select what set of benefits you desire.  You choose the Company offering the GAP policy, the Premium charged, and the Agent marketing the policies.  GAP policies do not include a drug plan.

     EXAMPLE:  An “F” GAP plan covers all three gaps in Original

                         Medicare.  A “C” GAP plan covers all gaps of Original

                         Medicare except Medicare Part B Excess Charges.

                         Etc. for A, B, C, D, F, HiF, G, K, L, M and N policies.

Part D or Prescription Drug —Stand-alone-Plans

There are 33 drug plans offered in Montana by private insurance companies.  Consider:

    Premiums:  From a low of $18.00 to a high of $110 per month

    Deductibles:  Range from $0 to $320 per year

  Formulary:  Companies place drugs on one of up to 5 Tiers. Each drug has a co-pay determined by placement on a Tier.

Part C or Advantage Plans

Offered by individual insurance companies contracted with CMS.  Only a few policies are available in Montana.   Advantage Plans basically “cover” Original Medicare and some cover Drug coverage.  Advantage Plans identify an “In-Network Provider List” so one knows which providers accept the lowest or preferred co-pay from the insurance companies.  All providers who accept Medicare accept the Advantage Plans.  However one would normally pay a higher Co-pay to those considered “out-of-network”.

       If one chooses an Advantage plan, consider the insurance company offering the plan, monthly premium, co-pays for in-network and out-of-network providers  and the Drug Formulary which identifies the Tier a drug is placed and the co-pay for that drug. Select an agent who will work for you.

 Written by:

Duane “Pete” Pettersen                                                                                      1-800-565-7354

Missoula, MT inspete1@gmail.com

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