Medicare Advantage – A Personal Story

The following account provided excerpts from a seniors perspective of the medicare advantage. According to him, he had recently turned 65, and was being barraged with information on what type of Medicare plan to choose. After just about three months on Medicare he was happy so far with a Medicare advantage plan. He chose the advantage plan with secure horizons, that is, no additional premium after the charge for Medicare part B has been deducted from my Social Security check.

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It is vital at this point to hear his actual account as it sort to shed light on several issues while simultaneously answering several questions. “My co-pays with this plan are as follows: $15 for a visit to my primary care physician… $30 to see a specialist (I needed a referral from my primary care physician to see a specialist) As well as $175 for an outpatient surgical procedure. In 2011, my co-pays will be $10 to see a primary care physician and $35 to see a specialist. The co-pay for an outpatient surgical procedure remains the same at $175”.

The next point he raises seemed to provide more of an idea on the procedure – “If I had a Medicare supplement plan, called Medigap plans, I would pay an extra $123 a month. For this extra premium I would eliminate the office co-pays, surgical copayments,and the co-pays or special procedures not covered in my Medicare advantage plan. For instance, he required a CAT scan, and got a surprise when he went to have the CAT scan performed as CAT scans are not covered under my Medicare advantage plan. Asides this surprise I was glad with the coverage that I receive with my Medicare advantage plan.

If you are a healthy person, it is recommend you stay on the Medicare advantage plan. If you see the Dr. a regular basis I would take a strong look at a Medigap plan, which eliminates all your co-pays and would’ve take care of my CAT scan. You have to do something extra as well to get your drugs covered with a Medigap. Prescriptions under Medicare advantage have usually been under $10.

Firms tend to offer an early enrollment discount for those who enroll in their plan within a certain time period after turning 65. This discount usually is reduced over time; however, when enrolling at or near age 65, the discount can make one company’s rates better than another.