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Health News Florida

Which Medicare Path Do I Take?

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(Editor's Note: It's Medicare enrollment season, now through Dec. 7, and beneficiaries are trying to decide on a plan. Health News Florida’s Carol Gentry, who has covered Medicare for many years, is seeing the federal program from a new point of view: as a beneficiary. Her first commentary, which aired Oct. 9, was "Medicare's Complexity Can Be Scary." The second one, "Which Medicare Path Do I Take?" is below).

Now that I’m semi-retired, I have time to visit parts of the world that are new to me, like China. I want to go while I’m still healthy enough to hike on the Great Wall. But can I afford it? That’s a consideration as I enroll in Medicare.

Should I sign up for a Medicare Supplement? Or should I go for Medicare Advantage, an HMO?   

When I talked about it with a doctor I know, he said get the Supplement.

“My name is Dr. Ken Wolinar, I’m a board-certified family-medicine physician in Boca Raton. When you sign up with Medicare Advantage, an HMO-type plan, you’re so restricted of who you can see, you only find out later when you actually have to use the services.  The ones that are sick,  that realize they have all these restrictions, they say, 'Oh shoot, what did I get myself into?'”

But going for a Supplement has a big down side: Cost.   To start with you’ve got the Part B premium that is deducted from your Social Security check, about $100 a month. That’s supposed to be deducted no matter what kind of plan you get, but actually, some Medicare Advantage plans will pay most of that for you.

 

The supplement can be, like, $200, $250 a month. Then  You have to get the drug plan, another  $30-40 dollars, if you’re fairly healthy. So altogether, a Supplement’s going to cost you, about $300 a month. That’s a good chunk of change." 

There’s another problem with Supplements: They let you go to any doctor, but you don’t really know how good the doctor is. On the other side, Medicare Advantage,  Medicare does a rating system using a 5-star scale. Medical things, customer service, they  take it all and they award stars.

I went to www.Medicare.gov and  found the least expensive plan in my county: WellCare Dividend. But it only has 3 ½ stars. The next two plans both have 4 ½ stars and they’re nearly the same price as WellCare. They have no premium, plus they pay back nearly all of Part B.

The other day I told a friend, Deby Cassill, how I picked out a plan:

Me: The plan I picked you’ve probably never heard of. It’s called Optimum.  

Deby: That's a great name.

Me: What most people do if they’re sitting with a helper, they say this is my doctor, this is my heart specialist I want to keep, this is the pharmacy I use , I took the opposite tack. I said I don’t really care what pharmacy I use.  I care what doctor I have, but I can do the research.

Deby: You’re not wedded to a doctor just out of habit.

Me: If I don’t get what I want from the plan, I know how to bite people’s ankles until I get what I want. I know how to be assertive. Now, if I’m too sick to be assertive on my own behalf, I’m counting on my friends to bite ankles for me.

Deby: So, Optimum.

Me: Do you know the letters POS?

Deby:  I’ve seen them but I’ve no idea what they mean.

Me: Point of Service. What it means is, and this is important, I can go out of the network and pay 30% of the bill myself. So it’s like a get out of jail free card!

Deby: That’s exactly what it is!

Me: Isn’t that perfect?

Deby: And you get to go to China.

Me: And I get to go to China!

P.S. Now granted, not everybody would make a decision the way I did. I’ll let you know how it works out.

--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.