Navigating Medicare Coverage Options

Navigating Medicare Coverage Options

By TIR Staff

Roughly 10 million baby boomers become Medicare eligible each year and begin the process of assessing the various options available for their health care coverage. It can be daunting says Candace Reistrom, a local agent for United Healthcare Medicare.

The former Willis North American agent is the daughter of an insurance broker and began her career doing employee benefits for large hospitals.

Candace Reistrom with United Healthcare Medicare is dedicating her insurance career to helping people find the right Medicare coverage. She holds meetings and visit opportunities throughout open enrollment, this year between Oct. 15 and Dec. 7 as well as during the spring.
TIR Photo.

“When my mom went on Medicare, I said, ’Oh mom, don’t worry I know everything about insurance. I’ll find you a Medicare plan.’ She went to a meeting similar to the ones she holds and said her head was spinning when she left. “I thought, ‘Oh my gosh, how can people go through this?’” That is when she decided to focus solely on helping people with Medicare.

In addition to the complexity of Medicare, eligible people get bombarded with advertising, direct mail, even knocks on their doors; some tactics which are against strict Medicare rules established by the CMS (Center for Medicare and Medicaid Services.) “You’re turning 65, so you become a celebrity.”

Original Medicare is provided by the government and includes Part A which covers hospital stays (deductibles apply) and generally has no premium, and Part B which covers doctor and outpatient visits (deductibles apply). The latter has a monthly premium that for new enrollees in 2017 was $134 per month. Drugs are not covered.

Beyond basic Medicare are two options for additional coverage. Medicare Supplements (Medigap policies) are offered by private companies and cover some of the costs not paid by Original Medicare. All supplemental plans must offer the same benefits per CMS; the only difference is their cost. For drug coverage supplement participants must buy a separate Medicare Part D plan; also offered by private companies. Supplements are not network plans so plan-holders may go to any doctor or specialist that accepts Original Medicare.

This screenshot from shows the various ways you can search for Medicare plans. Searches can be filtered by ratings, premiums, plan name, lowest estimated health and drug cost and lowest deductibles among other filters.

The second option is to choose a Medicare Advantage plan. Advantage plans are provided by private companies approved by CMS and include Medicare Part C which combines Original Medicare Parts A and B and most offer Part D drug coverage under one plan. Medicare Advantage Plans can be HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations).

People turning 65 have seven months to enroll (apply) beginning with the third month before their birth month and the following three months.Once in Medicare, recipients have the opportu- nity to review and change their coverage during open enrollment, Oct. 15 through Dec. 7 this year.

“And you have to keep in mind that the plans change,” adds Reistrom. “If you’re in an HMO or PPO type plan you need to make sure your doctors are included. You need to look at your drug coverage. What worked with you last year may not work for you this year.”

Calculating what your drug plan will cost over the year is more important then selecting a plan just because it has a low premium which could mean higher co-pays.

She recommends only using for research. “Go directly to the source,” she adds.
She also advocates working with an agent. “An agent is not necessary or required, but I think that an agent should be your advocate, help you through and hopefully tell you what the best decision is for you. This is an important decision, and you want to be sure you’re being guided in the right direction.”

Tom Torgersen, President of AIA Insurance Services concurs, “There are many Medicare options and most folks need advice from a professional to help them make the best decisions regarding coverage. The choices made when originally eligible for Medicare can have a lasting impact and limit future options. Those impacts should be explained to the clients so that they can make the best decisions for their health moving forward.” He offers AARP and Humana plans.
There is no charge to use an agent.

For additional information go to; Candace Reistrom, United Healthcare, 727-434-1803; Tom Torgersen, AIA Insurance Services, 727-577-7222.