Medicare Insurance in NJ – Paying too much?

Medicare Supplement Plans

Do you think you may be paying too much for your Medicare Insurance? Have you ever tried to compare rates since you signed up for your current plan? And if so, how long has it been?

Is it worth the trouble to try and research companies to change plans or should you just stay with your current carrier because they have been paying your bills timely and you haven’t had much hassle?

Well, options for Medicare Insurance have changed dramatically in the last few years. In New Jersey, there are eighteen or more insurance companies now selling Medicare Supplement plans when just four years ago there may have been around five or six. The benefits for the Medicare Supplement Plans A, B, C, D, F, G, K, L, M, and N are exactly the same for each similar letter no matter which company provides the plan. The plans and benefits are federally controlled by the Centers for Medicare and Medicaid. All of the insurance companies selling supplemental plans must pay their customers’ bills in a timely manner. The big difference may be in the price and service. A premium difference of $30 to $80 or even more per month could mean a savings of $360 to $960 or more per person for the year! Changing to one of the newer benefit plans, if appropriate for you, could mean even larger savings!

It is not a difficult process to change Medicare Supplement Plans and it can be done at any time throughout the year. Some companies even allow applications to be taken over the phone by the agent and signed through email. The main concern is your current health status, your answers to the health questions and your medications. There are many differences in these application questions between insurance companies. Some have height and weight tables and some are more lenient. Generally, you cannot have any known or planned upcoming surgeries or procedures that have not been done yet. And you should always provide thorough and accurate information to your insurance agent so that all aspects of your health can be considered when analyzing different plans. Make sure you trust in your agent’s desire to provide the best insurance for you at a price that you are comfortable with and sometimes that may mean staying with your current policy.


Medicare Advantage Plans

What about the zero dollar premium plans that are advertised on television? These are Medicare Advantage Plans and there are also many different companies presenting new plans each year. Medicare Advantage plans are available according to the county in which you live. Options and availability can vary greatly across a state. Medicare Supplement plans offer a policy holder more “choice” and you pay more to have that unlimited ability to choose your healthcare providers. You can basically go to any doctor or hospital that accepts Medicare anywhere in the country when you have a Medicare Supplement Plan like those mentioned earlier.

There are many differences in the types of Medicare Advantage Plans and how their benefits work. There are HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PFFS (Private-Fee-For-Service), POS (Point of Service), SNP (Special Needs Plans), MSA (Medical Savings Account) Plans and combinations or variations of these plans again depending on the state and county in which you live. The companies offering plans in Atlantic County may be different from the companies that have plans available in Ocean County and still different from Bergen County Medicare Advantage Plans etc. Most Medicare Advantage plans have a network of hospitals and doctors and you generally need to receive services inside of your network to incur just the normal charges or co-payments. Some plans do allow you to go outside of your network by charging higher payments when you do and some areas offer the Private-Fee-For-Service (PFFS)  plans which have their own rules and regulations for benefits. Some do not require you to pay a monthly premium as the zero dollar plans or the amounts of premium can vary greatly depending on the benefits offered through the plans.

Medicare Advantage plans have co-payments for doctor visits, hospital stays, and medical tests, etc. These amounts will vary according to the company sponsoring the plan and the actual plan that you might choose.  Also, the maximum out of pocket that a beneficiary might have to pay if faced with a major illness could reach up to $6,700 for the year. However, these plans are excellent for Medicaid and assistance eligible individuals because the government assistance programs will help pay the out of pocket costs and allow the beneficiaries to have more choice in doctor and hospital services while having a very small or no monthly premium payment.

Also, Medicare Advantage plans are great for those people who are very healthy and don’t seek medical services often. The money saved in premiums could be put into a savings account in case there would ever be a need to pay unexpected out of pocket costs. Or perhaps someone already has a Health Savings Account (HSA) to use for this purpose.

Another great savings feature of a Medicare Advantage plan is the built-in Medicare prescription drug benefit included in some plans. This benefit can save the additional monthly premium usually spent on the stand alone Medicare Part D Prescription plans amounting to hundreds of dollars for the year! You must investigate to find out whether your preferred doctors, hospitals and prescriptions are part of a plan that you are considering.

Also, many Medicare Advantage Plans offer additional benefits not found in Medicare Supplement Plans. These added benefits may include dental, vision and hearing. Some plans may offer the Silver Sneakers gym benefit if it is available in the area. These items can all add value to your Medicare Insurance. Read the details carefully for each level of plan to see what works best for you.

Medicare Advantage plans are for everyone regardless of health status. There are no health questions asked except for end stage kidney disease or dialysis because Medicare has special provisions for those situations. It is purely a matter of choice for each individual whether a Medicare Supplement or a Medicare Advantage plan would be better for you based on the contentment to receive any current or future healthcare services within a certain geographic area and how much money you want to pay or save.

prescriptionsMedicare Part D Prescription Plans

I had my prescriptions run on a program to see which Medicare Part D company would be best for me, so I should be ok now, right? Perhaps, if it was not too long ago, but you should really have your prescriptions run every year because the Part D plans do change a lot with each new year. Sometimes the companies may add or delete drugs from their plans, revise their benefits and also prescription co-payments and monthly premium prices do change. One of your common prescriptions may be one of the least expensive on one company’s plan and one of the most expensive on another company’s plan. That is a way to attract business to a company and also to earn income for it. And that can always change. There may be thousands of dollars of difference between companies with the same list of prescription medications.

One common problem is that people sometimes leave a drug off of a list that they give to an individual who is running the comparison program because it is only used occasionally. That “once in a while” inhaler or skin cream can really make a big difference in your cost. If you did not present it when the drugs were run, you may find that it is not even offered on the plan you chose and you will pay the full retail cost for it each time you fill the prescription. Make sure that you include all of your prescriptions when having them analyzed for the best Part D plan for you.

Also, your medications may change and even one new prescription can make a difference in the plan you should have. Some people chose the premium plan or most expensive level of a company’s Part D plans thinking it would provide them the best coverage. Many times, the value version of a company’s plans provides the same benefits for their particular needs at a much lower rate of premium and can save hundreds of dollars.

Remember there may be thirty-some Medicare Part D companies serving your New Jersey county area and each may have 2 or 3 different benefit plans. You need to look at your total annual cost and not just the monthly premium you will pay. You must also consider the annual deductible. It is up to each individual company to decide if they want to pass along that cost to the consumer or if they don’t want to charge it or charge a lower amount.

Using mail order through a Prescription Part D Plan may be a great way to get additional savings on your annual drug costs. Not all Part D Plans offer this benefit but there have been significantly lower overall costs on some of these plans in the last few years. Also, many Part D plans offer minimal or no co-pays for your drugs if you use one of their major name preferred pharmacies.

Also, in the last few years, there have been greater differences in pricing at different pharmacies when using the same Part D prescription plan. Have your plan information run using several of your favorite pharmacies. All of this does take a lot of time and patience but can make a huge difference in what you pay for the year in your drug costs, sometimes hundreds or thousands of dollars!

So, even though this is just a brief outline of factors to consider in the cost of your Medicare Insurance, you can see that there are many points to think about. Choose carefully and have a trained agent assist you. On this website, we can not post actual Medicare benefit information or pricing. However, per your request via phone or email, we can directly email information out to you or make an appointment to go over your options.

You can find more specific information about Medicare on the government website by clicking here.